saskatoon health region...portfolio was jointly led by sandra blevins, dr. alan casson, and jackie...

A N N U A L R E P O R T

Saskatoon Health Region

2 0 1 2 - 2 0 1 3

Saskatoon Health Region

Tableof Contents

Letter of transmittal -------------------------------------------------------------------------------------------------------------- 4Message from the President and CEO ----------------------------------------------------------------------------------------- 5Introduction ---------------------------------------------------------------------------------------------------------------------- 6Regional Health Authority Overview ------------------------------------------------------------------------------------------- 72012-13 Quick Facts ------------------------------------------------------------------------------------------------------------ 8Alignment with Provincial Direction -------------------------------------------------------------------------------------------- 9

Kaizen Promotion Offi ce brings good change to the Region ----------------------------------------------------------------10A ‘Made in Saskatchewan’ maternal and children’s hospital ---------------------------------------------------------------12New primary health centre opens at Whitecap Dakota First Nation --------------------------------------------------------14Surgery 4B opens to rave reviews at St. Paul’s --------------------------------------------------------------------------------166100 Oncology leads the way with 95 per cent hand hygiene rate --------------------------------------------------------18

Factors, Trends and Opportunities ---------------------------------------------------------------------------------------------20Healthy Children, Healthy Families, Healthy Communities ------------------------------------------------------------------22Our Team ------------------------------------------------------------------------------------------------------------------------22Key Partners ---------------------------------------------------------------------------------------------------------------------23Governance ---------------------------------------------------------------------------------------------------------------------24Saskatoon Health Region Overview -------------------------------------------------------------------------------------------26

Progress in 2012-13 --------------------------------------------------------------------------------------------------------------35Better Health ---------------------------------------------------------------------------------------------------------------------36 Strengthen patient-centred primary health care by improving connectivity, access and chronic disease management --------------------------------------------------------------------------------------------36Better Care-----------------------------------------------------------------------------------------------------------------------43 Transform the patient experience through sooner, safer, smarter surgical care --------------------------------------44 Safety culture: focus on patient and staff safety -------------------------------------------------------------------------48 Improve patient fl ow for patients with complex medical needs -------------------------------------------------------51Better Teams ---------------------------------------------------------------------------------------------------------------------52 Safety culture: focus on patient and staff safety – zero workplace injuries --------------------------------------------52Better Value ---------------------------------------------------------------------------------------------------------------------53 Identify and provide services collectively through a shared services organization ----------------------------------54 Deploy a lean management system including training, infrastructure across the health system with an initial focus on the surgical value stream and 3P within Five Hills, Prairie North, Prince Albert Parkland and Saskatoon ----------------------------------------------------------------------------55

2012-2013 Financial Overview -------------------------------------------------------------------------------------------------57

Glossary --------------------------------------------------------------------------------------------------------------------------58

June 13, 2013Honourable Dustin DuncanMinister of HealthDear Minister Duncan:Saskatoon Regional Health Authority is pleased to provide you and the residents of Saskatoon Health Region with its 2012-2013 annual report. This report provides the audited fi nancial statements and outlines activities and accomplishments of the Region for the year ended March 31, 2013.The Region continues to work toward its vision of Healthiest People, Healthiest Communities, Exceptional Service.Saskatoon Health Region is very proud to report on the accomplishments and challenges of 2012-2013. We have been honoured to lead the way in early adoption of lean and the Saskatchewan Healthcare Management System. This new approach is dramatically changing the way we work, from the bedside to the boardroom. More than 2,500 employees and physicians, including members of the Saskatoon Regional Health Authority, have participated in Kaizen Basics and more than 80 leaders are completing, or have completed, lean leader certifi cation. We are seeing signifi cant improvements in the patient experience, reduction in defects and elimination of waste through more than 65 kaizen events, including rapid process improvement workshops, mistake proofi ng, 5S and kanban seminars. Visibility walls, gemba walks and daily visual management are becoming our new way of working and the Authority has incorporated many of these approaches in its own governance processes. We are extremely pleased that government has approved the detailed design for the new Children’s Hospital of Saskatchewan. Thousands of patients, families, other members of the public, staff and physicians are informing the plans for this new provincial hospital. Of particular note is our consultation with children and families in the northern part of our province. Their expressed desire for a colourful, homelike environment has and will continue to inform our plans. In addition, throughout the year, teams have been working on how we will deliver care in the new hospital, developing new models of care that will put patients and families fi rst and ensure care is safe and evidence-based. We continue to be proud of the progress we have made this year in achieving sooner, smarter, safer surgical care. Saskatoon Health Region has signifi cantly reduced the number of patients waiting six months or more for surgery and is well positioned to pursue our target of three months in 2013-14. The adoption of the surgical site infection bundle is helping us signifi cantly reduce surgical infections. Safety continues to be a major priority for Saskatoon Health Region. In addition to improvements related to falls prevention, medication safety and infection control, we have started to develop a provincial prototype for a safety alert/stop the line system. This system, which will eventually be rolled out across the entire province, will go a long way in developing a culture of safety and eliminating harm to patients and staff. We continue to practice stewardship with our funding. The Region hired an internal auditor in 2012-13 to continue to ensure the integrity of our processes and policies. The growth of our communities and the complexity of care we provide have placed signifi cant pressure on our resources. The year ahead will be a challenging one for us, both operationally and fi nancially. The success we have achieved this year is through the hard work and dedication of the many point of care staff, physicians and leaders throughout the Region. We remain committed to achieving better care, better health, better value and better teams for the people of Saskatchewan. Respectfully submitted,

Jim RhodeChairperson, Saskatoon Regional Health Authority

Letter of Transmittal

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Something extraordinary is happening in Saskatchewan. Across our province, an entire health system, including the Ministry of Health, all health regions, the Cancer Agency, Health Quality Council and other health service agencies are united in their focus on achieving better health, better care, better value and better teams. Saskatoon Health Region has the privilege of being at the heart of this transformation. The development of the Saskatchewan Healthcare Management System, based on the Global Production System, represents far more than new lean-based tools and methods to improve care and services. It represents a different way of thinking and approaching the work we do. In many ways it is like putting on new glasses which allow us to see what has always been in front of us, but now becomes so clear it can no longer be ignored. Above all, it is about putting patients fi rst. This means partnering with patients, clients, residents, families and communities to improve 'customer value' and reduce costs by eliminating waste in all its forms.The past year has been one of tremendous learning and growth. I am very proud of what we have accomplished together. I am inspired by what lays ahead. We have only just begun. It is time for us to refl ect upon and celebrate the improvements and the progress we have made. It is also time for us to renew our personal commitment to continuous improvement. Zero harm, 100% performance - these are our shared goals. We will accept nothing else.

Maura DaviesPresident and CEOSaskatoon Health Region

Message from thePresident and CEO

Saskatoon Regional Health Authority continues to stride towards its vision: Healthiest People, Healthiest Communities, Exceptional Service1 – this is our commitment to our patients, clients and their families, our teams and to ourselves.This annual report presents Saskatoon Health Region activities and results for the fi scal year ending March 31, 2013. It reports on public commitments made and other key accomplishments of the SRHA. Results are provided on our publicly committed strategies, actions and performance measures as identifi ed in the strategic plan. This report also demonstrates progress made on the SRHA commitments as defi ned in our 2011-12 strategic plan. The 2012-13 annual report provides an opportunity to assess the accomplishments, result and lessons learned, and to identify how to build on past successes for the benefi t of the people that receive care from Saskatoon Health Region. In order to ensure the highest standard of reporting, Saskatoon Health Region has:• Confi rmed all data with the relevant process owners• Requested information and data from the Region’s Strategic Health Information and Performance Support

(SHIPS) department. Prior to releasing the data, SHIPS confi rms the information with the senior leadership team

• Once all the data is compiled and the report is written, it is brought back to the senior leadership team for approval; when approval is given the report is presented to the Saskatoon Regional Health Authority (SRHA) for approval prior to being sent to the Ministry of Health.

The Region has an accountability agreement with the Ministry of Health. The accountability is the Region’s commitment to the Provincial hoshin kanri plan. Hoshin Kanri aims to involve staff from all levels of participating organizations in identifying the vital few priorities for the system, using current data as a guide for decision-making. The intention is to focus on and fi nish the work in these key areas and then move on to the next set of priorities in future years. This sequencing allows for breakthrough achievement over a short time, rather than slow and inconsistent improvement over a long time, as there are fewer areas to focus on at once. Foundational to the development of this plan are the Premier’s priorities announced January 13, 2012, the Minister’s priorities and the input from health regions.

The 2012-13 annual report includes:• Alignment with Strategic Direction – how the Region aligns its mission, vision, values, strategic directions, and

goals with the Provincial Strategic Plan.• Regional Health Authority (RHA) Overview – the overview describes, at a high-level, what the RHA does and

who its key partners are.• Progress in 2012-13 – this section presents the Region’s key results, activities, accomplishments, and

outcomes in 2012-13. • Management Report – this section refl ects management’s responsibility for the representations made in the

fi nancial statements and the fi nancial information in the annual report.• 2011-12 Financial Overview - The fi nancial overview compares 2011-12 fi nancial information to budget.

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Introduction

http://www.saskatoonhealthRegion.ca/about_us/strategic_home.htm.1

In 2012-13, the Region reorganized its organizational structure to better position it for success in achieving the provincial and regional priorities related to better health, better care, better value and better teams. Key features of the new structure include:• An Integrated Health Services portfolio that groups patient, client and resident services regardless of

where care is provided - urban or rural, hospital or community. Services will be organized not as traditional departments, but as value streams which refl ect the full range of services and care providers that are involved in each patient and family experience, with a goal of improved coordination and fl ow. These value streams are: surgical services, cancer care services, maternal and child services, mental health and addictions services, seniors health services, acute medical and complex care services (which includes emergency and critical care), and primary care and chronic disease management services. The Integrated Health Services portfolio also includes medical imaging, laboratory and pharmacy services. This large portfolio was jointly led by Sandra Blevins, Dr. Alan Casson, and Jackie Mann in 2012-13.

• Petrina McGrath leads the Quality and Interprofessional Practice portfolio, which includes a new Kaizen Promotion Offi ce, infection control, ethics services and other roles and functions to support and promote quality, safety, client and family-centred care and interprofessional practice.

• Nilesh Kavia, VP Finance and Corporate Services, is responsible for a range of administrative services, including fi nance, facilities, materials management, food and nutrition services and information technology.

• Bonnie Blakley leads the People and Partnerships portfolio, which combines our former People Strategies team with Population and Public Health and other functions to enhance the health of our internal and external communities and nurture a safe and joyful workplace. Dr. Cory Neudorf, Chief Medical Health Offi cer, is Bonnie’s dyad partner for Population and Public Health.

• VP Practitioner Staff Affairs includes what was formerly known as Medical Affairs. This portfolio supports recruitment, credentialing, contract management and other administrative services related to medical and dental staff. This VP also serves as liaison with the Colleges of Medicine and Dentistry with regard to medical and dental academic programs. Dr. Grant Stoneham was interim VP until Dr. George Pylypchuk assumed the position.

• The VP of Research and Innovation is a joint position with the University of Saskatchewan. Dr. Beth Horsburgh was on sabbatical and Jim Thornhill provided leadership for this portfolio starting in June 2012. This portfolio supports and promotes research, innovation, and evidence-based policy and practice throughout the Region.

The net effect of the new organizational structure includes:• One less layer of management, • Nine fewer director positions,• More balanced workloads,• Creation of new roles to support system integration and lead continuous improvement throughout the

Region,• A continued commitment to our shared dyad leadership model, with physicians and administrative

directors jointly leading all our clinical services.This change in structure is designed to support the Region as it continuously improves care and services. Quality improvement is part of everyone’s job, and always has been. The new lean-based approaches and tools will support this important improvement work, involving patients, families, physicians and care providers in new and meaningful ways.

Regional Health Authority Overview

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2012-13 Quick FactsDescriptive Indicators 2012-13

Primary Care Home Care - Number of Discrete Clients Seen 7,940 Home Care - Total Visits Nursing 208,409 HealthLine (RN & MH Queues) - Registered (Answered) Call Volumes 17,740 HealthLine (RN & MH Queues) - Registered Patient Volumes 22,892 MD Ambulance Calls / Responses 27,445

Acute Care Emergency Department Visits (urban & rural) 144,876 Inpatient Discharges (urban & rural) 39,561 Newborns (urban & rural)* 5,198 Adult & Child Patient Days (urban & rural) 293,852 Newborn Patient Days (excludes transfers in) (urban & rural) 17,860 Average Daily Census YTD (excluding newborns) - Urban only 750 Average Beds Open & in Operation (incl. delivery unit, excl. newborns) -

Urban Only 794 Average Length of Stay (in days) - Urban only 7.6

Diagnostic/Specific Procedures Number of Hip Replacements 988 Number of Knee Replacements 1,422 Cataract Surgery 4,068 Operating Room Volumes (Urban & Humboldt) 36,158 MRI Exams 25,093 CT Exams 38,217 Lab Tests 9,595,214

Seniors' Health and Continuing Care Number of Long Term Care Beds 2,255

Mental Health & Addiction Services Inpatient Discharges (Dubé Centre Acute Care)* 1,061 Calder Centre - Resident Days 13,106

Population and Public Health Immunizations (all types) 146,941 *Preliminary (projected to year end based on Apr-Dec 2012 coded data)

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Alignment with Strategic Direction

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Kaizen Promotion Offi ce brings good change to the RegionLisa White knows ‘good’ when she sees it. As Infrastructure Lead for the Kaizen Promotion Offi ce (KPO), White has seen fi rsthand what a lean management system in health care can accomplish. “To go to Seattle Children’s Hospital and to see another lean hospital in action makes me so excited for our patients and our families and for our staff because I know what ‘good’ can look like,” she says.The Kaizen Promotion Offi ce, formerly Quality Services, is the glue that holds all the improvement work and Saskatoon Health Region’s lean management system together. The offi ce has three main functions: to provide planning and strategic direction for the organization, to provide the rules and tools of running kaizen events – making sure that all the events are run in the same way and are all supported, and also to provide support for training and certifi cation for all lean and kaizen events. “The offi ce is really intended to support and develop what the Region needs to be successful: giving people the skills and knowledge they need to work differently,” explains Candice Bryden, Director of the Kaizen Promotion Offi ce. Kaizen is a Japanese term that means ‘good change’ or ‘improvement’.In fall 2012, the kaizen infrastructure expanded to include the development of kaizen operational teams. Four teams were established to align with process redesign and improvement in the Region’s key service lines: surgery, maternal and children’s health, adult medicine and complex care, and support services). The pace has been hectic. Over the past year, there have been 31 rapid process improvement workshops (RPIWs), six mistake proofi ng projects, numerous 5S events, more than 2,800 staff and physicians have attended a one-day Kaizen Basics session, and 87 lean leaders are on track to be certifi ed. “We recognize that taking all of this on has been really challenging,” says Bryden. “However, as diffi cult as it feels at this point, after seeing what lean management systems look like in other places and our results so far, I don’t think we’re going to question that it’s worth it.”The logistics and organizing the resources and people required for the events can be daunting. But witnessing the emotional toll is often the toughest to manage. “There’s an emotional toll and there’s this energy that happens in event week,” says White.

To completely understand the work done within and through Saskatoon Health Region, it is important to include the voices of our patients, residents, clients, families and staff. The following collection of stories

helps provide a more complete picture of Saskatoon Health Region.

Included with each story is a unique QR code. Scan the code with your smart phone for additional video and internet links. Visit your app store for a free QR code scanner.

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Once event week is over, the Kaizen Promotion Offi ce, kaizen operational team, RPIW process owners and sponsors have even more work to do to maintain progress.Bryden and White agree that the best part of their job is watching partnerships develop during each event week and having patients involved in the process. “The untapped talent that we have in this organization and the results and solutions that participants come up with never ceases to amaze me,” says White. “That’s where I see the ‘good’ and that’s how I know we can get there.”What does it take to become a lean leader?Saskatoon Health Region is working with John Black and Associates (JBA) to develop lean leaders across the organization. Included in the process is the certifi cation of selected leaders. JBA’s certifi cation track requires participants to:• Take value stream mapping training.• Complete lean leader training – a three-day education module.• Complete a Module Deep Dive – training in 10 key lean modules.• Complete a Module Marathon – demonstrate knowledge of modules through “teach backs”• Take a team lead role and a sub-team lead role in a RPIW.• Serve as a participant in an additional RPIW.• Complete a Mistake Proofi ng project.• Complete a North American tour for education and coaching on the mistake proofi ng project and to visit

other lean hospitals in action - Seattle Children’s Hospital and Virginia Mason Medical Center.The initial focus for lean leader certifi cation is for senior leaders, the Kaizen Promotion Offi ce and the fi rst four service lines. There will be opportunities for more Health Region staff to participate in lean training in the future. Currently, all employees are encouraged to enrol in the Kaizen Basics course to obtain common background knowledge about lean.

The Kaizen Promotion Offi ce, formerly Quality Services, is the glue that holds all the

improvement work and Saskatoon Health Region’s lean management system together.

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“The ongoing participation of all our Saskatoon-based design team members was key to this phase. And just as important was the participation of children, teenagers and parents from

across Saskatchewan who took the time this past spring and summer to share their ideas and feedback with us.”

~ Craig Ayers, Project Director, Children’s Hospital of Saskatchewan

A “Made in Saskatchewan”Maternal and Children’s Hospital

Early interior design concept of the main lobby area. For more renderings, please visit saskatoonhealthregion.ca/chs.

In May 2012, when parent Andrea Lavalleé walked into the Meadow Lake auditorium for a community design session on Children’s Hospital of Saskatchewan, she made this point: “The main thing I wanted to get across is when we talk about accessible, we think that accessibility means how we get a child in a wheelchair into a room,” she explained. “What accessible really means for families who use a power chair is how can they participate in an accessible area? How can they participate in all the activities? Not just get one swing (or) one mat. That the design is all inclusive. That’s what accessible means.”Insight from Lavalleé and other parents and families from across Saskatchewan has added a level of richness to the detailed design of Children’s Hospital of Saskatchewan

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(CHS). The design development report for CHS was submitted by Saskatoon Health Region to the Ministry of Health in December 2012.This report is the culmination of eight months of intense design work by project team members, architects, and most importantly, hundreds of staff, physicians, patients and families. Detailed design looks at how each room should be set up – including family areas. The teams also worked to develop the list of equipment and furniture needs.This phase included four rounds of week-long sessions with design teams and equipment planners from May to September 2012. The fall was then spent fi nalizing the plans and creating the design development report. “We are so thankful for everyone’s dedication and hard work in creating this submission, especially our patients and families,” says Craig Ayers, Children’s Hospital of Saskatchewan Project Director, Saskatoon Health Region. “The ongoing participation of all our Saskatoon-based design team members was key to this phase. And just as important was the participation of children, teenagers and parents from across Saskatchewan who took the time this past spring and summer to share their ideas and feedback with us.”The project team knew it could not travel to every area in the province. They chose fi ve communities based on current users of pediatric and maternal services in Saskatoon. They also considered the desire for this hospital to refl ect the cultural and regional diversity of Saskatchewan as recommended in the provincial Patient First Review.Hearing the voice of children and teenagersWithin the communities of Stony Rapids, La Ronge, Ile a la Crosse,

Meadow Lake and Kerrobert, the project team visited 12 classrooms and worked with more than 250 children and teenagers from Grades one to 12 to capture their design ideas. The team also asked for, and received, more than 200 completed design activities that were mailed from children and teenagers, primarily from central and southern Saskatchewan. Working with Royal University Hospital school teachers and the recreational therapist, design concepts by current pediatric patients were captured and fed into the design process. And fi nally, children and teenagers at the July 2012 CHS Open House in Saskatoon, and at the FSIN Health and Wellness Conference in August 2012, completed design activities to enhance the project team’s information.Health-care Facility Site ToursDuring the community visits, the team toured local health-care facilities and talked with local care providers about their needs and challenges. To obtain additional information on First Nations design concepts, the team visited the All Nations Healing Hospital in Fort Qu’Appelle, Saskatchewan. All the tours added to information already gathered by the project team through tours of children’s hospitals in Canada and the United States in previous years.Talking with provincial parents and familiesThe project team invited local parents and families to talk about their needs and wants for the new hospital. This was further enhanced by a design session in June in Saskatoon for newcomers, along with on-line surveys asking families their opinions on what should go in the lobby and their interior design preferences for the maternal fl oor and neonatal intensive care units.Construction at Royal University Hospital site well underway.Meanwhile, extensive work is

underway at Royal University Hospital with parkade construction and site preparation work for the new hospital. A new helix ramp system for the parkade is being built, the parkade expansion is nearly complete, and work has started to create one of two new entrances for both RUH and CHS. Next steps in building the maternal and children’s hospitalAs the team continued through the review and approval process with detailed design, they prepared for the next phase of work with architects, engineers and design teams on the hospital’s design documents (blueprints). That work is expected to take most of 2013.“This phase will allow us to really bring the vision to life as we add in the details of the mechanical, structural and electrical elements of the building which will give contractors the information they need to build,” explains Ayers. “It will also allow the project team to have the last pieces of information it needs to create the complete image of what the new maternal and children’s hospital will look like when the doors open.”Through 2013, the team will focus on further developing the interior design palette for the hospital. This work will be supported by a team which includes families and front-line staff and physicians. This may involve further input from patients and families from across Saskatchewan.And it’s that opportunity to have a say which prompted Lavalleé to attend Meadow Lake’s design session last spring. “I am just so excited that people were taking the time to come up north and talk to us and listen,” she explained. “I am going to sleep a lot better now that I said my piece and whatever happens, happens. But at least I know I was a small part of it.”The detailed design of the new hospital was unveiled in April 2013.

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New primary health centre opens at Whitecap Dakota First Nation

This project involves providing primary health-care services on the Whitecap Dakota First Nation reserve with an emphasis on

Chronic Disease Management (CDM) in a more appropriate cultural environment.

Whitecap Dakota First Nation residents will fi nd it easier to look after their health-care needs thanks to the opening of a new primary health centre in the community.Whitecap was one of eight innovation sites across the province selected to test innovative approaches to primary health care though modeling a collaborative partnership between Whitecap Dakota and Saskatoon Health Region. In May 2012, the Ministry of Health announced $50,000 in funding for Saskatoon Health Region to go towards co-sharing a project coordinator to support the work at the Whitecap Dakota Primary Health Centre.“We are pleased that Whitecap Dakota First Nation is testing a new approach to primary health care, to better serve the needs of patients,” Minister of Rural and Remote Health Randy Weekes said at the announcement. “We hope this innovation site will inspire other First Nations communities in their effort to improve health-care services for residents.”

The Province is investing $5.5 million in 2012-13 to test innovative models of primary health-care service delivery and assist health regions to stabilize health services. The Centre also fi ts with Health Canada’s goal to improve health outcomes for First Nations across the country and Health Canada contributed $200,000 through its Health Services Integration Fund to support the opening of the new primary health centre.“This project improves the integration of federal and provincialfunded health services,” said the Honourable Lynne Yelich, Minister of State for Western

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Economic Diversifi cation on behalf of federal Health Minister Leona Aglukkaq. “The partnership among the Whitecap Dakota First Nation, the Saskatoon Regional Health Authority, the Ministry of Health, and the Government of Canada is another good example of how working together can improve First Nations access to health care.”This project involves providing primary health-care services on the Whitecap Dakota First Nation reserve with an emphasis on Chronic Disease Management (CDM) in a more appropriate cultural environment. There will be a focus on population health, education and disease prevention. Services will be more accessible and the community will have greater opportunity for collaboration and development of services that will meet their needs.“Saskatoon Health Region has developed an Aboriginal Health Strategy specifi cally to help improve health outcomes for Métis people and First Nations, both off and on reserve,” says Jim Rhode, Saskatoon Regional Health Authority Chair. “This partnership allows us to take an important step to improve health services for this population in a patient fi rst approach that makes best use of provincial and federal

government resources.”One role for the project coordinator will be to bring the appropriate stakeholders together to determine the needs of the community and to build a Primary Health/CDM service team to support the health of this First Nations community. “This new partnership with Saskatoon Health Region, and the Governments of Saskatchewan and Canada is consistent with Whitecap’s approach to building alliances to enhance services and quality of life for the community and area,” said Whitecap Chief Darcy Bear. “Our vision includes innovations in how health care that bring providers together, so that the best care possible can be provided.”A strong primary health-care system provides access to high quality care delivered by a team of health professionals that meets the needs of patients and families of all ages in any health-care setting. It is a holistic approach to health and recognizes that health is infl uenced by many factors outside the traditional health system. This new model of health care will serve as an example and learning site for others wanting to engage with First Nations communities in different ways.

The Whitecap Dakota First Nation Primary Health Centre opened in September 2012.

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Surgery 4B opens to rave reviews at St. Paul’s

“Love the colours!”

“The rooms are so spacious!”

“The frosting on the (patient room) doors look great!”

“Love the colours!” “The rooms are so spacious!” “The frosting on the (patient room) doors look great!”These were just a few of the overwhelmingly positive comments overheard at the staff open house held in August 2012 on Surgery 4B in St. Paul’s Hospital. The open house gave staff the opportunity to see the completed unit prior to the fi rst patients arriving the next day.One of the most popular parts of the open house was an explanation of the high-tech nurse call system. It uses sensors mounted in the ceiling throughout the unit to locate staff and allow wireless communication among care providers, a unique system within St. Paul’s Hospital.The clock started ticking on the Surgery 4B renovation project at St. Paul’s Hospital in May of 2011. Just 16 months later, thanks to the efforts of many dedicated people both within the Region as well as outside contractors and architects, the unit has opened to surgical patients. For Saskatoon Health Region, the project has set a new standard. Not only in the way the project was organized, but also in how lean methodologies were incorporated into the unit to optimize the physical space and streamline and standardize processes. The unit was offi cially turned over to the Region by the contractors at the end of July. The new unit staff began their orientation on July 30, and just two weeks later surgical patients arrived.

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“The unit is something special,” says Jenny Bartsch, Director of Surgical Services and project lead. “The amount of time and effort that went into this project by everyone involved has really paid off.”Turning the 4th fl oor of St. Paul’s into an 18 private-bed surgical unit required complete demolition, right down to the concrete pillars, and rebuild of the area. “We know staff and patients had to overcome noise and vibrations from the construction work. The planning team says thank you for your patience.”To learn more about Surgery 4B please visit www.saskatoonhealthregion.ca.

Staff orientation for the new Surgery 4B at St. Paul’s Hospital began on July 30. In just 16 months, the old space was

demolished and the new fl oor was completed.

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6100 Oncology leads the way with 95 per cent hand hygiene rate

“Be persistent, be the broken record. Our ultimate goal is still 100 per cent compliance so we are going to keep talking, keep reminding and keep making sure patients know that it’s okay to ask us if we’ve

washed our hands. We want them to ask.”

~ Donna Jouan-Tapp, Manager, 6100 Oncology Unit, Royal University Hospital

As a manager in 6100 Oncology, Jouan-Tapp encourages patients and family members to ask their care providers if they have washed their hands. Four years ago, the unit’s hand hygiene compliance rate was hovering around 60 per cent. Now, monthly hand hygiene audits show that the unit is leading the way in the Region with a 95 per cent compliance rate. Saskatoon Health Region is putting renewed emphasis on proper and consistent hand hygiene, especially at the point of care. Proper hand hygiene is a sure-fi re way of preventing the spread of most health-care acquired infections.

“Because our patients are immuno-compromised, anything we can do to aid infection prevention and control benefi ts and protects them,” explains Jouan-Tapp. “We incorporated hand hygiene into our ward orientation, our education days, and even into Releasing Time to Care™. Hand hygiene is an essential part of how we provide care.”Sue Bollinger, clinical nurse specialist, agrees. “Everyone on the unit needs to know what is expected. Educating patients and their families about hand hygiene empowers them to ask.” Oncology has two hand hygiene auditors who conduct monthly audits. “Our auditors don’t just observe. They fi nd teaching moments and look for opportunities to reinforce proper hand hygiene,” says Jouan-Tapp. Having that example on the unit makes it easier for staff to talk to one another and even call each other on improper hand hygiene. “Our culture makes it okay for staff to challenge each other. All patients are vulnerable to

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infections but ours have no immune system, so correcting someone isn’t a professional courtesy, it’s for the good of the patients,” explains Bollinger.The Oncology Unit’s hand hygiene success began with some ‘home improvements.’ “We gave the unit a facelift,” says Jouan-Tapp, adding everything was taken off the walls which were then cleaned, repaired

if cracks needed fi lling and repainted. “The focus was on cleaning our environment for infection prevention but it went beyond that when we got a sink installed at the entrance to the unit. That sink began acting as a visual cue, connecting the clean unit to clean hands.”Jouan-Tapp admits that a lack of sinks can be a barrier to performing hand hygiene which is why Isagel is stationed inside and outside every room. “We also took that into consideration when we were designing the Bone Marrow Transplant Unit. Every room has an additional sink right by the door and in the patient’s sightline.” Overall, Jouan-Tapp says in order to improve hand hygiene, it has to be at the forefront of everyone’s mind. “Be persistent, be the broken record. Our ultimate goal is still 100 per cent compliance so we are going to keep talking, keep reminding and keep making sure patients know that it’s okay to ask us if we’ve washed our hands. We want them to ask.”

Oncology 6100 had a 95 per cent hand hygiene compliance rate in 2012.

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Factors, Trends and OpportunitiesThe People We ServeDemographics and GeographyThe make-up and distribution of the province’s population provides some insight into the pressures that the health system can anticipate over the next few years. Population growth continues to be strong across Western Canada and Saskatoon is leading Canada in population growth at a rate of 4.1 per cent. The population increase has been largely attributed to newcomers. Saskatoon has seen a surge in net in-migration which hit a record estimated at nearly 6,100 people in 2012. As Saskatoon continues to experience unprecedented population growth, the demography of Saskatoon Health Region catchment area also needs to be considered. Saskatoon Health Region is seeing an increase in people age 60 years and older. In 2011 48 per cent of all people 60 years and older resided within Saskatoon Health Region catchment area (including Prairie North, Heartland, PA, Keewatin Yatthe, Churchill, Kelsey Trail); this is the point in life where individuals consume greater amounts of health care.This population increase is coupled with a greater tendency for the population to centralize around larger urban centres. As a result almost half of the province’s population is located in Regina and Saskatoon. This aggregation of the population in urban centres has led to many smaller communities being challenged to maintain basic primary and acute care services. One of the key challenges for Saskatchewan is to develop a means by which to meet the healthcare needs of a widely dispersed rural population while keeping up with the signifi cant service demands in the large urban centres. The expectation is that the overall Saskatchewan population will continue to grow with the majority of this growth occurring in larger urban centres and communities with specifi c economic opportunities. The total population of Saskatchewan is projected to increase to 1.22 million by 2030 under current assumptions and models. The effect of this increasing population trend is an anticipated corresponding increase in demand for all types of health-care services.An Aging PopulationSaskatchewan has an aging population as shown by the decline in three of the four young age groups and the increase in the next two older categories. Between 2003 and 2009, the population dropped for 0-14, 15-24 and 35-44 age categories, while increasing slightly in all other age groups except the 65+ category. There has been a slight decrease in the over 65 age group, but this is expected to increase signifi cantly over the next several years.The following table indicates the general aging of the Saskatchewan population.

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Source: Statistics Canada, Demography Division, Annual Pop. Estimates, Table 1

ID = Final Intercensal estimatesPP = Preliminary Postcensal estimates.

SoSoSSS ururcece:: StStStStStSt ttttatatiiiiisistitititititicscs CCCCCCanan ddddadadaa IDIDIDIDIDID == FFFFFFiiiiinin llllalal IIIIII ttttntnterercecensns llllalal ee ttttststiiiiimim ttttatateses

Saskatchewan Population by Age Group as a Percentage of Total Population, 2003 and 2009

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

0-14 15-24 25-34 35-44 45-54 55-64 65+

Age (Years)

Dis

trib

utio

n

2003 2009

With the increase in the number of older adults in the province’s population, it is expected the number of people with dementia will also be on the rise and there is a need to begin discussion and planning now. The Alzheimer Society of Saskatchewan states that there are now 500,000 Canadians with Alzheimer’s and it is expected to increase to 1.1 million in a generation. It now costs $15 billion to care for these patients and is expected to increase to $153 billion in a generation. Canadians now spend 231 million hours providing informal care and it is expected to increase to 756 million hours.A Growing Aboriginal PopulationSaskatchewan has a large Aboriginal population. The largest portion of the Aboriginal Peoples population is the First Nations population, which make up 64.4 per cent. Of self-identifi ed First Nation individuals, approximately 52.3 per cent live on reserve. The majority of First Nations individuals living off reserve are located in Prince Albert, Saskatoon and Regina. In 2010, 13.57 per cent of our population reported Aboriginal identity, compared with 3.4 per cent across Canada.Saskatchewan’s Aboriginal population is also young, with 34 per cent of the Aboriginal population aged 0-14, compared to 20 per cent of the non-Aboriginal population aged 0-14 per cent. The demographic characteristics of the Aboriginal population in Saskatchewan have implications regarding the location and type of health-care services delivered. Tuberculosis rates continue to be high in several groups including First Nations, Métis and ethnic immigrant populations, and where there are housing issues such as in northern remote communities and on First Nations reserves. Saskatchewan has the fi fth highest rate of tuberculosis in the country, at 8.8 cases per 100,000 population, which is much higher than the national average of 5.0 cases per 100,000. Of the incidence of tuberculosis in Saskatchewan, 88.5 per cent are seen in the Aboriginal population.

Saskatchewan’s HIV rate as of 2010 was the highest in Canada and the highest risk populations are injection drug users, young women, and those of Aboriginal ancestry. The Saskatchewan HIV Strategy 2010-2014 received approval in December 2010 and is posted on the Ministry of Health website. The strategy was developed with extensive consultation with a variety of stakeholders: health regions, First Nations and Métis governments, community-based organizations, and other non-health sectors such as municipal governments. The strategy’s main goals are to prevent the transmission of HIV and to improve the quality of life for HIV-positive people. The strategy contains a number of activities in four key areas: community engagement and education; prevention and harm reduction; clinical management; and surveillance and research.A Newcomer PopulationSaskatchewan’s rate of population growth through immigration has grown signifi cantly in recent years. The rate of international immigration has more than doubled in recent years. From January 2006 to January 2011, an average of approximately 1,286 people per quarter immigrated to Saskatchewan from other countries. This compares with approximately 456 people per quarter from January 2001 to January 2006.In general, the Saskatchewan population over time has moved from rural populations to urban centres. In 1981, 50 per cent of the population resided in urban

Statistics Canada, Demography Division. Chart 3.33 Age pyramids (in relative value) of the Saskatchewan population, 2009 and 2036 (scenario M1)

Population by sex and age group, by province and territory; Statistics Canada, CANSIM, table (for fee) 051-0001.Population reporting an Aboriginal identity, by age group, by province and territory (2006 Census)

Tuberculosis in Canada 2006. Public Health Agency of Canada. Minister of Public Works and Government Services Canada, 2008

2

3

The following diagram shows the projected change in Saskatchewan population by age from 2009-2036. 2

4

4

21

3

22

centres. By 2010, that number had increased to 62 per cent. In terms of delivery of health-care services, the demographic pattern indicates greater pressure will be exerted on health-care facilities in larger urban centres than those in rural communities. This implies geographical considerations are important in determining where additional resources should be allocated.

Healthy Children, Healthy Families, Healthy communitiesWe know that a child’s healthy development - beginning with the mother’s health - lays the groundwork for a lifetime of health and well-being. When children’s physical and emotional needs are met and strengthened by positive early experiences at home and in their social and physical environments, they have greater potential to grow into healthy and successful adults. Healthy and successful adults, in turn, are the cornerstone of vital and productive communities. Simply put, if we care about the future prosperity, sustainability and well-being of our health region residents, it will be clearly refl ected by actions and policies that give our children a healthy start.In 2012, the Region’s Public Health Observatory published the Healthy families, healthy communities, healthy children: a report of the Chief Medical Health Offi cer on the health status and development of young children in Saskatoon Health Region. A key fi nding of this report, based on Early Development Instrument scores (EDI), is that 30 per cent of kindergarten-aged children in Saskatoon Health Region are vulnerable in at least one developmental area, including physical health and well-being, social competency, emotional maturity, language and cognitive development, and communication skills. This means that many children are not getting a healthy start. This indicator and several others revealed signifi cant health inequities in children living in the most deprived areas of Saskatoon and also among First Nations and Métis children. While there is some overlap between these groups, it is important to recognize that proposed solutions are complex. For example, just as the causes of poverty are complex, requiring us to look at many areas, such as how to improve policies of income distribution, education, employment, housing and food security, so too are the root causes of First Nations and Métis health inequities. While our First Nations and Métis communities have tremendous strengths, they also face challenges, and we need to understand the deeply rooted causes for why First Nations and Métis children continue to experience health inequities. These causes stem from a history of colonialism that has rippled across generations. The result has been a complex variety of historical, social, political and economic infl uences that have led to institutionalized racism, higher rates of poverty, barriers to health care and increased vulnerability to stress, all of which contribute to a greater burden of physical and mental disease and shortened life expectancy.

Our TeamEmployees: The average age of Region employees has decreased from fi scal year 2011-2012 to 2012-13 from 43.4 to 43.2 years. This likely refl ects shifts resulting from the retirement of staff and an increase in the numbers of younger staff replacing those workers. The trades group has the oldest average age at 49.9 years followed by out of scope managers whose average age is 48.7. RNs, who make up the largest occupational group, have an average age of 41.6 years - a drop from 42.2 years at the end of last fi scal year.

One issue of concern for the Saskatoon Health Region has been whether it will be able to replace retiring workers as the workforce ages. Over the last two years the number of employees retiring has remained fairly consistent – 309 in 2011-2012 compared to 292 in 2012-2013. These numbers are up slightly from 2010-2011 when 269 employees were identifi ed as retiring. This rate of retirement has been manageable.

Engagement: The commitment of Saskatoon Health Region to continuous improvement is dependent upon a workforce that is engaged. In 2011, a survey of employees found that 64 per cent of staff (including individuals employed in affi liates) had favourable levels of engagement. A sample survey carried out March to April 2011 found that number had increased slightly to 65%. By 2017 the objective is to achieve a favourable rate of

5 Urban populations include any locations with a provincial, regional, or district hospital, but excludes surrounding bedroom communities,which would further highlight the migration to urban centres.6 Neudorf C., Muhajarine N., Marko, J., Murphy, L., Macqueen Smith, F., Clarke A., Ugolini C., Wu J., Healthy Children, Healthy Families,Healthy Communities: A report of the Chief Medical Health Offi cer on the health status and development of young children in Saskatoon Health Region, 2012. (http://www.saskatoonhealthregion.ca/your_health/PHO/SHR_Healthy_Families_2012.pdf)

5

6

engagement by staff of 80 per cent.

Participation by clients: Saskatoon Health Region has engaged clients and their families through a variety of advisory groups and, in some cases, on an individual basis in the planning and evaluation of policy, programs, and unit/department functions. Members of the community serve on the Client and Family Centred Care Regional Steering Committee; as client/patient/family advisors; in Rapid Process Improvement Workshops; and on Client and Family Advisory Councils. Currently, 165 individuals serve in some capacity in these roles.

Key PartnersThe Region works closely with a number of affi liated agencies and other health-care organizations in providing services and programs to residents of the Region and the province. An affi liate, as defi ned by The Regional Health Services Act, is an operator (other than the Region) of a hospital or a not-for profi t special care home. A health-care organization, as defi ned by the Act, is an affi liate, or an organization prescribed in regulation, that receives funding from a RHA to provide health services.

Notes respecting relationship and accountability to the Region: * Operating agreement outlining contractual obligations; audited fi nancial statements ** Funding arrangement for services; audited fi nancial report

23

Affiliates Service Provided Bethany Pioneer Village Inc.* Long-term care services Circle Drive Special Care Home Inc.* Duck Lake and District Nursing Home Inc.* Long-term care and respite services Jubilee Residences Inc. (Porteous Lodge)* Long-term care services

Jubilee Residences Inc. (Stensrud Lodge)* Lakeview Pioneer Lodge Inc.* Long-term care and respite services Luther Care Communities (Lutheran Sunset Home)* Long-term care, respite and day program services Mennonite Nursing Home Inc.* Long-term care and respite services Oliver Lodge* Long-term care Saskatoon Convalescent Home* Long-term care, respite and day program services Sherbrooke Community Society Inc. (Central Haven Special Care Home)*

Long-term care services

Sherbrooke Community Society Inc. (Sherbrooke Community Centre)*

Long-term care, respite and day program services

Spruce Manor Special Care Home Inc.* Long-term care services St. Ann’s Senior Citizens Village Corporation* St. Joseph’s Home for the Aged* Strasbourg and District Health Centre ** Health Centre

Sunnyside Adventist Care Centre * Long-term care and respite services Warman Mennonite Special Care Home Inc.* Long-term care services

24222222222222222222222222222244444444444444444444444444444

Saskatoon Regional Health AuthoritySaskatoon Health Region is governed by an 11-member appointed Saskatoon Regional Health Authority, which is accountable to the Minister of Health. At the end of 2012-13, the Saskatoon Regional Health Authority members were:

The Authority was appointed by an Order in Council to a term not to exceed January 27, 2012. The Ministry of Health completed the process of reappointment of Authority membership on May 22, 2012, with three members not being re-appointed and with the appointment of four new members. For information on Authority members, visit www.saskatoonhealthregion.ca.The operation of Saskatoon Regional Health Authority was supported by seven Authority committees and one Council during 2012-13: Each Committee included three or more members of the Authority and had terms of reference defi ned in Authority policy.Roles of the Committees:

Executive Committee: Provides support to the Chair and the Authority; exists to deal with exceptional circumstances facing Saskatoon Health Region.Audit, Finance and Risk Committee: Oversees fi nancial reporting process, business risk process and adequacy of internal controls, relationships with external and internal auditors, fi nancial compliance issues, the internal audit function and major risks inherent to the business, facilities and strategic directions. Ensures management has effective systems of control. Facilitates the audit function and helps Authority members meet their audit, fi nance and risk responsibilities.Human Resources Committee: Provides oversight and ensures compatibility with the Strategic Plan of the human resources strategies and policies of the Health Region including CEO Evaluation.Partnership Committee: Saskatoon Regional Health Authority (SRHA) and St. Paul’s Hospital (SPH) Board: Assists the two Boards in carrying out their governance roles and enhances the effectiveness of the Partnership Agreement between the two.Policy and Governance Committee: Leads annual review of Authority policies and bylaws. Reviews new policies brought forward by other Authority committees. Identifi es revisions to the SRHA Governance Charter. Monitors and reviews Authority performance and conducts an annual, formal Authority evaluation. Helps facilitate the education and professional development of the Authority and its members. Leads the RHA in addressing Accreditation Canada governance requirements.Quality and Safety Committee: Assists the SRHA and the SPH Board in carrying out their governance role related to quality of care and patient safety throughout the Region. Dimensions of quality to be addressed by the committee include accessibility, equity, client centeredness, effi ciency, effectiveness, safety and competency.

Jim Rhode, ChairpersonColleen Christensen, Vice ChairpersonGary Beaudin

Randy Donauer Malcolm EatonRoss Huckle Frank Lukowich

Ann MuellerMegan RumboldMary Rose Silzer-QuinnMike Stensrud

Governance

Stakeholder Relations Committee: Ensures positive external stakeholder relations and ongoing assessment and analysis of effective stakeholder engagement in relation to policy and strategy for the organization.Practitioner Liaison Council: Serves as a liaison between the SRHA and the respective regional practitioner association and seeks, in a spirit of cooperation, to maintain and improve the provision of health services in the health region.

TransparencyThe Authority invites all members of the public to its monthly board meetings in the interest of transparency, and responds to questions from the community and the media. Saskatoon Regional Health Authority is responsible for maintaining and enhancing public confi dence in the health-care system and in the Region. This is done in a variety of ways, from ensuring timely access to quality services and being sound stewards of fi nancial resources, to the holding of regular public meetings.During 2012-13, the Saskatoon Regional Health Authority continued to take actions that support public transparency of its operations, including: posting notice of Authority meetings in communities within Saskatoon Health Region; issuing media advisories on Authority meetings and agendas; posting on a website the Authority meeting dates, minutes and information on Authority members; holding regular business meetings in public; reporting on Authority activities in the Region’s internal and external newsletters; issuing media releases for key announcements; and being responsive to media requests for information that are directed to informing the public. The Authority’s Governance Charter, which details roles, responsibilities, functions and structures can be found at http://www.saskatoonhealthregion.ca/about_us/policies/SRHACharter-approved.pdf.

Senior Leadership TeamSaskatoon Health Region’s Senior Leadership Team experienced change during the year with secondments and sabbatical leaves resulting in some roles being fi lled on an interim basis.

Maura Davies, President and Chief Executive Offi cerJean Morrison, President and Chief Executive Offi cer, St. Paul’s HospitalPetrina McGrath, Vice President, Quality and Interprofessional PracticeNilesh Kavia, Vice President, Finance and Corporate ServicesBonnie Blakley, Vice President, People and PartnershipsDr. Cory Neudorf, Chief Medical Health Offi cerSandra Blevins, Vice President, Integrated Health ServicesDr. Alan Casson, Vice President, Integrated Health Services

Jackie Mann, Vice President, Integrated Health ServicesGraham Fast, interim Vice President, Integrated Health ServicesDr. Grant Stoneham, Vice President, Practitioner Staff AffairsDr. George Pylypchuk, interim Vice President, Practitioner Staff AffairsDr. Beth Horsburgh, Vice President, Research and InnovationDr. Jim Thornhill, interim Vice President, Research and Innovation

Saskatoon Health Region OverviewSaskatoon Health Region provides a comprehensive range of health services in the areas of ambulance, rehabilitation, community, mental health, long-term care and hospital services. These services are delivered in more than 75 facilities across the region through hospitals, long-term care facilities, primary health-care sites, public health sites, and a variety of community and business locations and in private residences throughout the Region. While many of the facilities are owned and operated by the Region, we also work in partnership with affi liate health-care organizations. In addition, the Region enjoys a fully integrated interdependent partnership with St. Paul’s Hospital that is unique to any other that exists in Canada.The Region is an academic health-care organization with responsibility to facilitate education and research for the benefi t of Saskatchewan. This role necessitates a strong interdependent relationship with the University of Saskatchewan, the Saskatchewan Institute of Applied Science and Technology (SIAST), the First Nations University of Canada (FNUC), the Saskatchewan Indian Institute of Technologies, the Dumont Technical Institute and a variety of other regional colleges.On an annual basis, the Region provides training opportunities for more than 2,000 health sciences students in addition to students from non-clinical educational programs. Each student may have more than one placement in the Region within a year. Placements vary in length from part of a day to several weeks, depending on the education and training to be provided. We estimate that up to 4,000 placements occur in a year. The facilitation of research and innovation is integral to improving the care and services provided by academic health-care organizations.

What is Saskatoon Health Region?• The largest health region in the province, serving more than 318,000 local residents in more than 100 cities,

towns, villages, rural municipalities and First Nations communities • A provincial referral centre providing specialized care to thousands of people from across Saskatchewan • Residents in Prince Albert Parkland, Prairie North, Heartland, Kelsey Trail, and the three northern RHAs rely on

Saskatoon Health Region for more than 30 per cent of hospitalizations • An integrated health delivery agency providing a comprehensive range of services and programs including

but not limited to hospital and long term care, public health and home care, mental health and addiction services, prenatal and palliative care

• An organization providing services and programs in more than 75 facilities, including 10 hospitals (including three tertiary hospitals in Saskatoon), 29 long term care facilities, and numerous primary health-care sites, public health centres, mental health and addictions centres, and community-based settings

• The largest employer in the province with 929 physicians and 13,458 registered nurses and other health-care service and support workers and managers

• An academic health sciences centre supporting more than 300 research studies within the Health Region, providing training opportunities to more than 2,000 health sciences students, and taking part in health education and research for the benefi t of the province as a whole

• Supported by about 3,000 registered volunteers• A region with a geographical area of 34,120 square kilometres and a perimeter of 1,296 continuous

kilometres

26

Community Based Organizations and

Third PartiesService Provided Relationship and Accountability

to Saskatoon Health Region

AIDS Saskatoon Housing coordinator to develop low barrier housing model for HIV+ clients; Outreach workers and transportation expenses; Harm reduction supplies for needle exchange, and budget for community street patrollers April-Sept. Peer to peer program for 6 months (over March 31/13)

Contractual agreement; audited financial statements; Funding letter, and performance status reports collected quarterly

Autism Services Saskatoon

Provide a variety of intervention and support services to children and their families.

Contractual agreement outlining obligations. Monthly report.

Autism Treatment Services of Saskatchewan Inc.

Home and community-based support, counselling and treatment services to autistic children and youth and their families

Contractual agreement outlining obligations; quarterly reports and audits; annual financial report.

Avenue Community Centre

Enhances service provider training Funded through the Provincial HIV Strategy

Contractual agreement; audited financial statements.

Communauté des Africains Francophones de la Saskatchewan Inc. (CAFS).

AIDS Prevention in Immigrant Populations youth of French African decent in Saskatchewan

Contractual agreement outlining obligations, final report education outcomes.

Canadian Mental Health Association

Pre-vocational and vocational programs for adults disabled with long-term mental illness

Contractual agreement outlining obligations; monthly reports and audits; monthly statistics; annual financial report.

Central Urban Métis Federation Incorporated (CUMFI)

McLeod House provides transitional housing for 15 men with substance dependency issues for up to one year. There are also two short term respite beds.


Children's Therapeutic Classroom (Three Saskatoon School Divisions)

Therapeutic classroom for children with significant mental health disorders

Jointly funded services in kind.




Christian Jensen and Action Influence Communications

Germ Smart creative and development of promotional products for public hand hygiene campaign

Contractual Agreement one-time arrangement

Collective Kitchen Partnership

Contribution to operating Contractual agreement outlining obligations; annual financial report; SHR as member on Coordinating Group.

College of Dentistry, U of S

Research & strategy development of oral health care in SHR Long Term Care facilities

Assessment, survey and staff education.

Community Health Services (Saskatoon) Association Ltd.

Nurse practitioner Primary health services

Partnership agreement; annual report covering delivery of services, revenues and expenditures under agreement; accounts, records or information upon request.

CommunityView Collaboration

Steering Committee membership, staff in-kind support and co-sponsor support for the development and maintenance of the system.

Partnership with several members of the Saskatoon Regional Intersectoral Committee to fund the development and maintenance of CommunityView Collaboration, a web-based community information system aimed at supporting wellness in the community.

Cosmopolitan Industries Ltd.

Programming to enhance daily living skills for adults who are severely mentally and/or multiply challenged

No formal agreement; receive annual grant; annual report.

Crocus Co-op Transitional and supported employment, social and recreational programming for adults with mental illness/addictions


CRU Youth Wellness Centre, Inc. (April 1/12 –June 30/12)

Board membership, staff supervision and financial infrastructure support for Centre (operates on external grants).

Program partnership for youth engagement and mentoring.

Elmwood Residence Inc. Residences and programming for intellectually challenged individuals

No formal agreement; receive annual grant; annual report.

Friendship Inn Elder support for Saskatoon Friendship Inn during Sexual Health/Street Outreach STI & BBP testing

Contractual agreement outlining obligations, Quarterly report

Humboldt and District Ambulance Service

Pre-hospital ambulance and emergency care


In motion Partnership Contribution to social marketing strategy, raising awareness of the benefits of daily physical activity

Partnership agreement; SHR administers funds.

28




Lanigan and District Ambulance Association


Contractual agreement; audited financial statements; annual trip data.

M.D. Ambulance Care Ltd.

Pre-hospital ambulance and emergency care, inter-facility transfers

Contractual agreement outlining reciprocal obligations; monthly statistics; audited financial statements.

Midway Ambulance Pre-hospital ambulance and emergency care


Ministry of Justice (Young Offenders)

Addiction Services and Young Offenders

Contractual agreement outlining obligations. Yearly report.

Persons Living with AIDS Network (PLWA)

Outreach workers and transportation expenses for HIV+ clients

Contractual agreement outlining obligations, Quarterly report

Persons Living with AIDS Network

Outreach worker Funded through the Provincial HIV Strategy

Contractual agreement, financial statements

Poverty Awareness Workshop Team

Building Awareness of the impact of living in poverty

Financial management, facilitation assistance.

Quill Plains Ambulance Care Ltd.



Rosthern and District Ambulance


Contractual agreement; audited financial statements; monthly performance status reports.

Saskatoon Anti-Poverty Coalition

Contribution to operating expenses, in order to build capacity of those with a lived experience with poverty and to raise awareness in the broader community

Annual financial report.

Saskatoon Crisis Intervention Services, Inc.

Crisis management for adults disabled by mental illness/addictions and with problems maintaining connections with other agencies.


Saskatoon Housing Coalition, Inc.

Supportive/Transitional Housing and supportive counselling/life skills for adults with mental illness/addictions


Saskatoon Poverty Reduction Partnership

Contribution to communication strategy, raising awareness of the social determinants of health

Contractual agreement outlining obligations; regular reporting of funds; SHR has members on Coordinating and Leadership Groups.

Saskatoon Community Youth Arts Program (SCYAP)

Social Marketing project. Funded through Provincial HIV Strategy

Contractual agreement, financial statements

29




Saskatoon Tribal Council Urban First Nation Services Inc.

Partial funding for safe housePartial funding for harm reduction supplies Outreach worker and transportation support funded through Provincial HIV Strategy

Yearly audited statement.

Regular and annual report of needle exchange rates.

Funding letter, and performance status reports collected quarterly

Sexual Health Centre – Saskatoon

Support services to expand clinic hours

Contractual agreement outlining obligations, quarterly report.

Shamrock Ambulance Care Inc.



Strasbourg Ambulance Service



Student Wellness Initiative Toward Community Health (SWITCH)

Operational funds in student managed inter-professional clinic

Service agreement; provide financial and performance information on request.

The Saskatoon Downtown Youth Centre, Inc.

Residential transition service for youths with addictions


Three Saskatoon School Divisions

Case Management Project

Informal understanding. Transfer funds to SHR.

University of Saskatchewan Student Health Centre


Grant agreement; annual report covering delivery of services, revenues and expenditures under agreement; accounts, records or information upon request.

Wakaw Ambulance Service


Contractual agreement; financial statements; performance status reports provided on request.

Wynyard and District Community Health Clinic Assoc. Ltd.


Annual report and audited financial statements.

Young Women’s Christian Association

Respite and short term housing for women with mental health challenges

Contract under development.

Martensville Youth Community Development Team

Contribution to health promotion activities, addressing the determinants of health

Summary evaluation and financial report 6 weeks after completion of the grant.

Community Chronic Disease Outreach Program: Peer Leadership



Saskatoon Chapter, Saskatchewan Brain Injury Association, Walking for Fitness



Saskatoon Anti Poverty Coalition: Up and Out of Poverty



30




Kinsmen Activity Place – Walking the Journey Program



Wadena & Fishing Lake First Nation Collective Kitchen Project



SCYAP Streetgraphix Contribution to health promotion activities, addressing the determinants of health


Humboldt Senior Citizen’s Club Inc. Interative Theatre for Elder Abuse



Food Connections for All Contribution to health promotion activities, addressing the determinants of health


Sunset Estates Pre-School



Healthy Seniors on the Net



Saskatoon Council on Aging Inc.



St. Maria Goretti Community School

Contribution to classroom health promotion activities

Brief summary evaluation in June

Englefeld School Contribution to classroom health promotion activities


Valley Manor Elementary School



St. Mary Community School



E.D. Feehan Contribution to classroom health promotion activities


Bishop Klein School Contribution to classroom health promotion activities


Wadena Composite High School



31




Bishop Roborecki Contribution to classroom health promotion activities


St. Frances School Contribution to classroom health promotion activities


King George Community School



Sutherland School Contribution to classroom health promotion activities


Vincent Massey Community School



W.P. Bate School Contribution to classroom health promotion activities


Westmount Community School



Ecole Lakeview School Contribution to classroom health promotion activities


Princess Alexandra Community School



Pike Lake School Contribution to classroom health promotion activities


Clavet Composite School



Brunskill School Contribution to classroom health promotion activities


St. George School Contribution to classroom health promotion activities


Spectrum Core Community Services



Humboldt & District Community Services



Saskatoon Cycles Inc. Contribution to health promotion activities, addressing the determinants of health


32




The Community Chronic Disease Outreach Program



SWITCH Contribution to health promotion activities, addressing the determinants of health


Autism Treatment Services of Saskatchewan Inc.



Youth Launch Contribution to health promotion activities, addressing the determinants of health


St. Frances School Contribution to classroom health promotion activities


Clavet Composite School



John Dolan School Contribution to classroom health promotion activities


Sutherland School Contribution to classroom health promotion activities


Alvin Buckwold School Contribution to classroom health promotion activities


Prince Philip School Contribution to classroom health promotion activities


Father Vachon School Contribution to classroom health promotion activities


Lakeridge School Contribution to classroom health promotion activities


St. Alphonse School Contribution to classroom health promotion activities


Princess Alexandra Community School



Vincent Massey Community School



Englelfeld School Contribution to classroom health promotion activities


33




St. Philip School Contribution to classroom health promotion activities


St. Maria Goretti Community School



Delisle Elementary School



Martensville Community Access Centre



READ Saskatoon Contribution to health promotion activities, addressing the determinants of health


Saskatoon Council on Aging Inc.



34

Progress in 2012-13Our FrameworkIn 2012-13, for the fi rst time, the strategic plans of each health region were aligned as part of a provincial health plan in a process known as hoshin kanri, or strategy deployment. This was a process in which leaders, board members, Ministry of Health representatives, and health-care directors, providers and physicians from each region came together for consultation.The province will maintain its over arching health plan for the next three to fi ve years, while each region is responsible for creating short and long-term plans to meet these priorities, along with the health needs of their region’s population.The Hoshin Kanri process is intended to enable an organization to:

• Identify the critical few breakthrough priorities• Focus on shared goals• Communicate those goals to across the organization• Involve all leaders in planning to achieve the goals• Hold the organization accountable for achieving the goals

Provincially, there were fi ve Hoshins or areas of focus; • Transform the Patient Experience through Sooner, Safer, Smarter Surgical Care• Strengthen Patient-centred Primary Health Care by Improving Connectivity, Access, and Chronic Disease

Management• Deploy a Lean Management System including training and infrastructure across the health system with an

initial focus on the surgical value stream and 3P within Five Hills, Prairie North, PAPRHA and Saskatoon• Safety Culture: Focus on Patient and Staff Safety• Identify and Provide Services Collectively Through a Shared Services Organization

Saskatoon Health Region added two more Region-specifi c Hoshins - • Children's Hospital of Saskatchewan • Improve patient fl ow for patients with complex medical needs

Saskatoon Health Region experienced signifi cant volume increases in its service areas. The following chart shows where those increases occurred and the decreases in unit costs as the Region strives to be more effi cient.

35

Pressure or Volume Increase Volume Cost per Unit Volume Cost per

Unit (1)Cost per

Unit Volume Percent IncrementalCost - Mar/13

PICU Days 1,187 4605 1,648 3,791 814- -17.68% 461 38.8% 1,747,628NICU Days 10,197 1319 10,673 1,372 53 4.03% 476 4.7% 653,086Deliveries 4,869 2657 5,195 2,577 96- -3.61% 326 6.7% 839,977Acute Care Pediatrics 11,712 807 12,098 805 2- -0.27% 386 3.3% 310,771Mental Health Pat. Days-Adult 19,059 479 19,377 464 15- -3.13% 318 1.7% 147,552Mental Health Pat. Days-Child 2,492 479 2,687 464 15- -3.13% 195 7.8% 90,480Emergency Visits 115,154 297 117,502 299 2 0.67% 2,348 2.0% 702,317Food and Nutrition (Meal Tickets) 747,981 12 768,793 12 0 1.60% 20,812 2.8% 243,502Home Care Nursing Urban (Visits) 191,389 63 208,409 62 1- -1.81% 17,020 8.9% 1,054,049Home Care Nursing Rural (Visits) 24,749 64 26,693 62 2- -3.12% 1,944 7.9% 121,170Home Care Home Services Urban (Visits) 361,038 37 370,114 37 - 0.00% 9,076 2.5% 335,358Home Care Home Services Rural (Visits) 166,413 21 173,672 22 1 4.71% 7,259 4.4% 157,303Medicine and Surgery Days 188,372 529 193,371 552 24 4.46% 4,999 2.7% 2,761,837Medical Remuneration - Additional GIM Hospitalist 32,543 31 33,572 38 1,029 3.2% 338,928Year over year increase in Lab 2,887,000Year over year increase in Supply Chain 252,000Subtotal 12,642,956Deficit reported at March 31, 2012 7,075,000Higher costs in Rural Health - Operations 1,005,000Higher costs for Surgeries compared to targeted revenues 1,549,000Lower Sundry Revenue 1,068,000procurement savings and increased cost of demand maintenance) 899,431

Deficit March 31, 2013 24,239,387

Volume Change - Mar/12 to Mar/13

Change in Cost per Unit - Mar/12 to

Mar/132011-2012 2012-2013

Better HealthProvincial 5 year Outcomes Provincial Hoshins 2012-13 SHR Projects 2012-13

50% reduction in the incidence of communicable disease by (TB, HIV, STIs &MRSA) by 2017

Strengthen Patient-centred Primary Health Care by Improving Connectivity, Access and Chronic Disease Management

TB reduction strategy Clinical Practice Redesign in targeted Primary Care practices HIV strategic plan and implementation Hospice capital and operational plan Implement rural health strategy Primary Care Prototype Project if funded by Ministry

50% improvement in number of people surveyed who say “I can see my Primary Health Care Team on my day of choice” by 2017 50% reduction in age standardized hospitalization rate for ambulatory sensitive conditions by 2017

100% of seniors who chose to stay at home will be supported to do so as long as it is safe and economically efficient to do so by 2017

Hoshin: Strengthen Patient-centred Primary Health Care by Improving Connectivity, Access and Chronic Disease Management• Outcome: By March 2017, there will be a 50% reduction in the incidence of communicable disease (TB,

HIV, STIs and MRSA)• Improvement Target: By March 2017, increase by 50% access to HIV testing including point of care testing

for HIV and TB

What is being measured?

Includes all standard HIV test and rapid HIV point-of-care tests performed at all SHR sites on SHR residents in 2012 to 2013. Rapid Point of care (POC) HIV tests are rapid HIV tests administered by Population and Public Health (Sexual Health and Street Health), West Side Community Clinic and the Sexual Health Centre. A 50% monthly increase in HIV testing represents at least 1,997 HIV tests per month. Why is it important?

• SHR in the past accounted for approximately 50% of new HIV cases in the province in Saskatchewan

• HIV testing is recommended as good preventive health care for everyone, “Know your status”

• Should be offered as a part of routine medical care as per new provincial policy recommendations (PLT, 2013).

• POC test results are immediately available and are important for HIV testing populations who may not access conventional testing sites or return for

standard test results• Awareness of HIV status allows for behaviour

change to0 Reduce risk of HIV acquisition by HIV-negative

individuals0 Reduce risk of transmission by HIV-positive

individuals• Allows for early initiation of antiretroviral therapy

0 Benefi ts HIV-infected individual0 May also reduce transmission to uninfected

partners

What were our results in 2012-13?

• In March of 2013 SHR met and exceeded the 50% testing increases targets set by the Ministry of health.

• Baseline based on data from Jan 1 to Dec 31, 2009, this is the year prior to the deployment of new HIV testing resources and policy in the

36

Number of HIV Tests performed in SHR April 2012 to March 2013

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

2400

Apr12

May

12

Jun12

Jul12

Aug12

Sep12

Oct

12

Nov

12

Dec12

Jan13

Feb13

Mar

13

No.

ofHIVTestsC

ondu

cted

Month

HIV POC tests HIV standard tests

1,997 Target

1,331 Baseline

2,149

province of Saskatchewan in preparation of the 2010 to 2014 Saskatchewan HIV strategy.

• An increase of 25% in POC tests performed from the fi rst quarter to the last quarter in the fi scal year 2012 – 2013

• During that same time HIV incident cases in SHR reduced from 66 new cases in 2011 to 55 new cases in 2012 a 16.6% reduction.

What are we doing about this?• For many, reproductive and sexual health services

are the entry point into the medical care system. These services improve health and reduce costs by not only covering pregnancy prevention, HIV and STD testing and treatment, and prenatal care, but also by screening for intimate partner violence and reproductive tract cancers, providing substance abuse treatment referrals, and counselling on nutrition and physical activity.

• HIV screening fi ts nicely in to this bundle of services at various entry points in to the health-care system as knowing ones HIV serostaus slows the transmission of HIV through testing and treatment as people who are infected with HIV know their status and can take efforts to reduce the onward transmission of HIV through the adoption of safer behaviours and participating in HIV treatment in an effort to make them less infectious.

• Further expansion of POC testing to appropriate sites in SHR is planned.


HIV, STIs and MRSA)• Improvement Target: By March 2017, increase by 50% access to point of care testing for HIV and TB

What is being measured?TB Control Saskatchewan is requesting clients age 14 years of age and older who have active TB or Latent TB Infection to have HIV serology testing done. Data on the number of clients who have documented HIV serology test results is collected (sixty nine out of seventy four – 69/74).Why is it important?This is important due to the rising rate of HIV in Saskatchewan as TB/HIV co-infection is a signifi cant risk factor for TB clients who are HIV positive. Immune defi ciency induced by HIV infection alters the skin

test result, and the clinical and radiological feature of TB. Knowing the HIV status of clients is vital for the TB Physician to ensure accurate and effective management.With the increase in foreign born individuals coming to the province, it is important to know their HIV status as many are from countries where HIV and TB have a higher prevalence. If clients are identifi ed with previously undiagnosed HIV infection, a referral is made to HIV specialists.

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What were our results in 2012-13?Following 90 days from the date of diagnosis, HIV test results are extracted from the TBIS database. The range is 94 – 100%. No results are known for March as the clients tested in that month did not reach the 90-day target. What are we doing about this?We are continuing to request clients have HIV testing and are monitoring the obtaining of results.

0.010.020.030.040.050.060.070.080.090.0

100.0

Apr

May Jun

Jul

Aug

Sep Oct

Nov

Dec Jan

Feb

Perc

enta

ge

Percent of Saskatchewan Active TB cases aged 14+ Tested for HIV - 3 Month Rolling

Percentage 2012 - 2013

Baseline

SK

Goal

Date Prepared: May 21, 2013Report Contact: Dr.Assaad Al-AzemSource: Data provided by TB control ProgramRefresh cycle: Monthly - trailing 3 month score reportedOperational Def:Percent of TB cases tested for HIV (Aged14+ )(active cases)(90+ Days after Diagnosis)Baseline: Fiscal 2012-2013.

Plan Baseline

Target (all) = 90%Rolling 3 Months Average (Feb)= 94.1%


HIV, STIs and MRSA)• Improvement Target: By March 2013, 79% of children are up to date on publicly funded vaccines (MMR)

by age 2. . By March 2013, 92% of children are up to date on publicly funded vaccines (MMR) by age 7

What is being measured?Two doses of measles containing vaccine are part of the standard immunization schedule for children in Saskatchewan. They are given at 12 months and 18 months of age. Measles containing vaccines currently being used in Saskatchewan also contain vaccine to prevent mumps and rubella, so the graph is labelled as MMR immunization coverage.For the fi rst chart each monthly data point is a calculation of the percentage of children turning two years of age in the most recent three months who were up to date (had received two doses of measles containing vaccine by their second birthdate) for children with active records.The percentage for the fi scal year 2012/13 is the sum of all monthly numbers of up to date children for the year, divided by the sum of the monthly numbers of children turning two with active records, expressed as a percentage. Similar calculations are made for children turning seven years of age.Why is it important?Two year old and seven year old coverage are standard measures of the effectiveness of immunization programs in Canada. The two year

old coverage assesses programs directed at infants, whereas the seven year coverage refl ects the strength of preschool programs and the ability to bring children up to date who are behind at school entry.The percentage that is not up to date is also to some extent a measure of risk for the diseases involved, although it should be remembered that a signifi cant number of children who have not received 2 doses of MMR will have received one dose, and most of them are protected.

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In the pre-vaccine era the highest rates of disease and serious outcomes were in the youngest children.Other vaccines, of course, are given in early childhood, and although they are not refl ected in these data, calculations using other types of coverage indicators show similar trends.What were our results in 2012-13We chose a stretch target for the year of 79%. The last three monthly data points in the graph are at or above that level. The overall percentage for the year, however, was lower than the target, refl ecting lower coverage rates in the fi rst 9 months. The trend looks encouraging. Most of this change is likely due to expansion of the “done by two” program, in which public health staff focus on under immunized children between 20 and 24 months of age in rural and urban middle and upper income neighbourhoods, along with the Saskatoon core and core fringe. The program started in December and was fully operational in January.The higher seven year old coverage rates refl ect ongoing efforts by public health staff to bring under immunized children up to date at the time of school entry.What are we doing about this?To capitalize on the success of “done by two” and accommodate for the added workload, the school program will be adjusted to enable nurses to focus on

children under 7 years. This means children behind in grades 2-5 will not be immunized in school but rather brought up to date when they reach grade 6 and are due for hepatitis B vaccine. Other strategies focussed on urban neighbourhoods/rural communities with lowest coverage will continue as resources allow. If there is enough funding, we will continue the “done by two” program and continue to work on different strategies in under immunized neighbourhoods.Regarding the seven year old coverage rates the coverage rates are stable, and we are looking for more effective ways to use the available resources directed at preschoolers and children at school entry.

Hoshin: Strengthen Patient-centred Primary Health Care by Improving Connectivity, Access and Chronic Disease Management• Outcome: By March 2017, there will be a 50% improvement in number of people surveyed who say, “I can

see my primary health-care team on my day of choice”• Improvement Target: By 2015, all SK residents, who choose to be, are connected to a primary health-care

team that includes or is linked to a family physician

What is being measured or done?Percentage of Saskatchewan residents connected to a primary health-care team.Why is it important?A primary health-care system that is sustainable, offers a superior patient experience, and results in exceptionally healthy Saskatchewan population. Primary health care is a holistic approach to health and recognizes that health is infl uenced by many factors outside the traditional system. What were our results in 2012-13?As of March 2013 25.66% of the total SHR population was covered by Primary Health-care Team. However, there are limitations to this data as it only includes up to quarter 2 and as of quarter 4 Watrous was added as a primary health-care site. What are we doing about this?We are continuing to engage with new communities

regarding development of Primary Health-care teams to increase coverage throughout the Region. By 2017, 80% of primary health-care teams are engaged in Clinical Practice RedesignWhat is being measured or done?Percentage of primary health-care teams engaged in clinical practice redesignWhat are we doing about this?Advancement of clinical practice redesign is being aligned with Lean. This is not a target in 2013/14. By March 31, 2017, there will be a 50% improvement in the number of people surveyed who say, ‘I can contact my primary health-care team on my day of choice’What is being measured or done?Percentage of patients reporting they were able to contact their primary health-care team on the day of their choice.

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Why is it important?Access is one of the key principles of Primary Health Care. To provide effective health-care services clients must be able to see their primary health-care team on the day of their choice.What were our results in 2012-13?A baseline has not been established. What are we doing about this?We are currently working with Saskatchewan Health Quality Council to develop a client experience survey that aligns with the provincial survey and Hoshins. It is expected that a survey will be ready to pilot in June 2013.By March 31, 2017, there will be a 50% reduction in the age-standardized hospitalization rate for ambulatory care sensitive conditions.What is being measured or done?Age standardized hospitalization rate for ambulatory care sensitive conditions.Why is it important?This measure will guide chronic disease prevention and management strategy.What were our results in 2012-13?In 2010-11 the provincial rate of ambulatory care sensitive condition hospitalizations was 478 /100,000 (hospitalizations/total population). The PHC outcome and improvement target for 2013/14 – 2016/17 relates to 6 specifi c chronic conditions: diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), depression, congestive heart failure, and asthma. Data on incidence, prevalence and hospitalizations for the 6 conditions is being gathered to facilitate reporting in 2013.What are we doing about this?We are currently developing a plan to spread the newly developed clinical practice guidelines to all primary health-care providers. Use of guidelines will be facilitated by the Med Access EMR where available and an e-portal developed by eHealth. By 2017, 75% of patients with chronic disease report an increase in confi dence to self-manage their disease. What is being measured or done?Currently there is no available baseline measure. There are several programs and services, including LiveWell with Chronic Conditions and exercise programs, offered to SHR clients that focus on self-management of chronic disease. Why is it important?Self-management techniques and strategies encourage healthy behaviours and improve health outcomes.What are we doing about this?We are currently working with Saskatchewan Health Quality Council to develop a client experience survey

that aligns with the provincial survey and Hoshins. It is expected that a survey will be ready to pilot in June 2013. The survey will contain a question addressing confi dence in self-management. We are also developing a client experience survey that can be used by our chronic disease programs/services. By 2017, 80% of patients are receiving care consistent with provincial standards for the fi ve most common chronic conditions. What is being measured or done?Percentage of patients receiving care consistent with provincial standards for the six most common chronic diseases. Percentage of patients receiving care consistent with provincial standards for the six most common chronic diseases. Why is it important?Providing care consistent with provincial standards provides excellent patient experience and reliable care.What are we doing about this?We are currently developing a plan to spread the newly developed clinical practice guidelines to all primary health-care providers. Use of guidelines will be facilitated by the Med Access EMR where available and an e-portal developed by eHealth. By 2017, 80% of primary health-care teams are using electronic medical records that facilitate individual patient care and enable population-based reporting for quality improvement and planning. What is being measured or done?Currently 65% (11 of our 18) sites are using Med Access. In the next 12 months at least 2 additional sites, Whitecap Dakota First Nation and Watrous, will integrate Med Access into their daily work processes. Why is it important?Electronic Medical records increase the quality and safety of patient care in a number of ways, including but not limited to, improved communication between team members, increased reliability of care, more effi cient entry of client information, e-referrals, etc.What were our results in 2012-13?During 2012 -13, one site (Wynyard) implemented Med Access. Primarily, EMR efforts were focused on lab integration and associated training. What are we doing about this?Primary Health and CDM have developed an EMR oversight committee to develop an implementation and spread plan to ensure training, upgrades, and future site implementations continue at the appropriate pace.

40

Hoshin: Strengthen Patient-centred Primary Health Care by Improving Connectivity, Access and Chronic Disease Management• Outcome: By March 31, 2017, seniors will have access to supports that will allow them to age within their

own home and progress into other care options as their needs change• Improvement Target: Hospice capital and operational Plan

What is being measured or done?In 2012 Saskatoon Health Region began strategic planning to determine the need for a dedicated Hospice Service within the Palliative Care Continuum. A project Team was established and a Project coordinator was hired to; conduct a needs assessment of current and future palliative care needs; engage key internal and external stakeholders; complete a Value Stream Map for palliative care clients; identify the client population that will be served by a hospice and establish client criteria; update the operational plan; develop a functional plan; confi rm the site for the hospice and assist the St. Paul’s hospital foundation in the development of a fundraising campaign. Two reports were completed that summarize the fi ndings.The result of this work also included the development of an interagency committee representing stakeholders with a common interest and desire in providing end of life care across the continuum. Why is it important?Saskatoon’s population is aging and growing, with the current and future projected needs for palliative care beds and services indicating a growth based on the research and data analysis conducted. A hospice provides an appropriate care environment for the provision of end of life care as part of the continuum of Palliative Care. Providing Palliative care in the appropriate environment reduces the need for acute care patient beds for individuals who do not require an acute care bed or whose needs can no longer be met in the community.

This is a better care hoshin, impacting appropriate care for palliative clients and increased capacity for clients requiring acute care.What were our results in 2012-13?The value stream map of the patient journey identifi ed the current and future state and star burst opportunities. The needs assessment and research conducted, identifi ed that Saskatoon Health Region would need 15- 24 hospice beds in addition to the current palliative care services offered. In addition the project team identifi ed models of care that improve patient fl ow and quality of life for end of life care and options to consider for implementing a hospice in Saskatoon Health Region.What are we doing about this?The fi nal report of the hospice project team will be shared with senior leadership and the community reference group and will be reviewed in context of the current Saskatoon Health Region and provincial Hoshins.Saskatoon Health Region will continue to address opportunities for improvement identifi ed in the Palliative Care value stream map to improve the patient journey experience and reduce waste; and will be reviewed in context of other service line value stream maps to identify current patient fl ow and opportunities for improvement.The community stakeholders reference group has been established to facilitate communication on work related to hospice care and to maintain the linkages across service lines and organizations providing support and care to individuals at end of life stage.

Hoshin: Strengthen Patient-centred Primary Health Care by Improving Connectivity, Access and Chronic Disease Management• Outcome: By March 31, 2017, seniors will have access to supports that will allow them to age within their

own home and progress into other care options as their needs change• Improvement Work: Implement rural health strategy

What is being measured or done?The 2010 SHR Rural Health Strategy contains 44 recommendations falling into 22 categories. Since the Strategy was endorsed by SRHA, the service lines impacted by the 44 recommendations have started work on the recommendations that fall within their area of responsibility. A review of progress conducted in the fall of 2012 has shown signifi cant progress in some areas and lesser amounts of progress

in other areas. In the spring of 2013, a Rural Health Stabilization Planning Committee was formed under the leadership of Graham Fast (now led by Sandra Blevins) with committee membership at the Vice President and Director Level. The work of the committee is to look at all services currently being offered in the rural part of Saskatoon Health Region and to work towards creating a sustainable plan ensuring that

41

the health-care needs of our rural communities are being effectively served in a planned, sustainable manner. This includes developing a stable physician complement, implementing the community paramedicine model, developing collaborative emergency centres and increasing access to primary health care.The recommendations contained in the 2010 SHR Rural Health Strategy are being used to guide the work of the committee.Why is it important?The 2010 SHR Rural Health Strategy contains 44 recommendations encompassing a wide variety of issues intended to provide direction to Saskatoon Health Region with respect to the signifi cant issues impacting rural health in the Region (Taken from page 5 of Strengthening Rural Communities: A Summary of Saskatoon Heath Region’s Rural Health Strategy, 2010).In some cases, the recommendations are straight forward and are written in a “just do it” sort of way and were very easy to operationalize. Some of the recommendations are more complex in nature and require strategic implementation plan. The work of the Rural Health Stabilization Planning Committee will help to develop an implementation plan to help move the more complex recommendations forward.What were our results in 2012-13?While progress continues in some areas, many of the recommendations in the 2010 SHR Rural Health Strategy have not moved forward or have made little

progress, some due to fi nancial constraints, some due to competing priorities within the service line affected and some waiting for further direction or coordination through an implementation plan. What are we doing about this?The creation of the Rural Health Stabilization Planning Committee has provided the needed focus and impetus to get things moving forward again. In addition, Saskatoon Health Region has created the position of Integration Director-Rural and has assigned working on the 2010 SHR Rural Health Strategy as part of the role.The continued work of establishing Community Health Councils in our rural communities is also providing opportunities for meaningful engagement and consultation as the planning process moves forward. We now have active councils in the communities of Cudworth, Delisle, Wadena, Wynyard, Nokomis, and Watson. Work in establishing Community Health Councils is well underway in Watrous, Wakaw and Humboldt.Finally, a review is underway to see which recommendations contained in the Rural Health Strategy fi t within the current Saskatoon Health Region and Provincial Hoshins. These will become a priority for work this year. The other recommendations may become “daily work” or may have to wait until additional resources are available. Work on the development of Collaborative Emergency Centres would be an example of work supported by Provincial and SHR Hoshins.

42

Better CareProvincial 5 year Outcomes Provincial Hoshins 2012-13 SHR Projects 2012-13

By March 31, 2017 patients’ ratings of exceptional overall health care experience are in the top 20% of scores internationally

Transform the Patient Experience through Sooner, Safer, Smarter Surgical Care

Prostate assessment pathway Uro-gynecology pathway SPH 4th floor renovation Expanding surgical services at SCH to help meet regional volume targets Breast Health Centre expansion Colorectal screening Surgical Information System

By March 2017 there will be a 50% reduction in patient wait times from GP referrals to specialist and diagnostic services By March 2014 all persons have the option to receive necessary surgery within 3 months By March 2015 all cancer surgeries or treatments are done within the consensus time frames from the time of suspicion of, or diagnosis of cancer By March 2017 no adverse events related to medication errors

Safety culture: focus on patient and staff safety

Stop workplace injuries Hand hygiene: apply lean approach and best practises to improve Surgical site infections Medication reconciliation on admission to hospital and transfer to LTC

By March 2017 zero surgical infections in clean surgeries

No patient that requires emergency services will wait in the ER for care by March 2017

Patient Flow for patients with complex medical needs (SHR-specific breakthrough)

Complex care needs project

Children’s Hospital of Saskatchewan (SHR-specific breakthrough)

Conduct RPIWs, 3Ps and other CI projects related to CHS Complete next phase of CHS design and construction for CHS per project plan Develop eHealth implementation strategy and information flow for CHS Ambulatory Patients and Flow of Outpatients Project- funded by Canada Health Infoway

43

Hoshin: Transform the Patient Experience through Sooner, Safer, Smarter Surgical Care• Outcome: By March 31, 2014, all patients have the option to receive necessary surgery within 3 months• Improvement Targets: By March 2013, 100% of expected surgical case volumes by region delivered. By

March 2014 achieve the capacity needed to meet the established surgical throughput targets

What is being measured?The percentage of surgical cases that were performed within the time frame recommended by the Saskatchewan Surgical Care Network (SSCN) is determined every 2 months. The time frame being measured is time between the date a request for surgery is received from the surgeon and the date that the surgery takes place.Target time frames have been established in Saskatchewan according to the level of urgency for the completion of the procedure. The level of urgency is determined through the use of a provincially standardized Priority Scoring Tool used during the surgeon’s assessment of the patient. Priority levels range from Priority Level 1 (most urgent) to Priority Level IV (least urgent).Why is it important?Meeting the target time frames and performance goals established by the SSCN helps to ensure that patients receive surgery in time frames that are clinically appropriate for their situation. What were our results in 2012-13?At the end of March 2013, 710 patients had not been offered a date within 6 months of being placed on the surgical wait list and 2,130 patients had not been offered a date within 3 months of being placed on the surgical wait listWhat are we doing about this?In 13/14 focus will be upon:• OR scheduling process improvements which

includes clarifi cation of accountabilities and advanced notifi cation of OR theatre schedules.

• Awareness amongst surgeons of pooling processes and opportunities to support these processes available through Ministry of Health

• Continuing with the following which were initiated in 12/13:0 Bi-weekly OR utilization meetings with

Department Heads of Surgery and Anesthesiology, VP, Director and Scheduling manager

0 Wall walks on key indictors at Surgical Operations Committee meetings

Hoshin: Transform the Patient Experience through Sooner, Safer, Smarter Surgical Care• Outcome: By March 31, 2015, all cancer surgeries or treatments are done within the consensus time

frames from the time of suspicion of, or diagnosis of, cancer• Improvement Target: By March 31, 2015, all cancer surgeries or treatments are done within the consensus

time frames from the time of suspicion of, or diagnosis of, cancer. By March 31, 2017, there will be a 50% reduction in value stream waste for the provision of cancer surgery/treatment

What is being measured?The percentage of surgical cases that were performed within the time frame recommended by the Saskatchewan Surgical Care Network (SSCN) is determined every 2 months. The time frame being measured is time between the date a request for surgery is received from the surgeon and the date that the surgery takes place.Target time frames have been established in Saskatchewan according to the level of urgency for the completion of the procedure. The level of urgency is determined through the use of a provincially standardized Priority Scoring Tool used during the surgeon’s assessment of the patient. Priority levels range from Priority Level I

44

(most urgent) to Priority Level IV (least urgent). Invasive cancer surgeries are classifi ed as level I.Why is it important?Meeting the targets and performance goals established by the SSCN helps to ensure that patients receive surgery in time frames that are clinically appropriate for their situation. We must ensure that elective surgeries are not performed at the expense of priority surgeries, in order to achieve overall volume targets.What were our results in 2012-13?In 2012-13, the 67% of cancer surgeries were completed within 21 days of the booking request What are we doing about this?In 13/14, focus will be upon meeting the target time frame through the following:• Increased involvement of the clinicians and

physician leaders in the development of corrective action plans when targets are not met.

• Further refi nement of Breast Health Centre processes

• RPIW to decrease lead time from booking to surgery date

• Participating with the process being led by the MoH to review the current target time frames for cancer surgery.


frames from the time of suspicion of, or diagnosis of, cancer• Improvement Target: By March 2017, 10 specialties will have developed provincial standards of care

(clinical pathways) for their specialty and 80% of their patients will be receiving care consistent with those standards. By March 31, 2017, there will be a 50% reduction in value stream waste for the provision of cancer surgery/treatment.

Colorectal Screening (SHR)What is being done?Saskatoon Health Region has started participating in the screening program for Colorectal Cancer October 2012. The public receives a fecal immunochemical test (FIT) to fi nd blood in the stool that is not visible to the naked eye. The test is done in the privacy of home and then dropped off or mailed to a medical laboratory. A normal result means that blood was not found. The test will be sent again in two years if you are between the ages of 50- 74 years old. If the test fi nds blood the Screening program for Colorectal Cancer (SPCRC) will send the results to your doctor. Your doctor or the client navigator will contact you about appropriate follow up care which is usually a colonoscopy. All the screening colonoscopies are completed at Saskatoon City hospital. A colonoscopy can detect infl amed tissue, ulcers and abnormal growths.

Why is it Important?A doctor can remove growths, called polyps, during a colonoscopy and have the sample tested for signs of cancer. Polys are common in adults and are usually harmless. However, most colorectal cancers begin as a polyp, so removing polys early is an effective way to prevent cancer.What were our results in 2012-13Patients started coming to have their colonoscopies in December 2012. We have completed 186 screening colonoscopies from December to the end of March. As more people receive their letters to participate in the program the numbers of colonoscopies will increase.What are we doing about this?We are encouraging the public to participate in the screening program for colorectal cancer as early detection saves lives.

45


frames from the time of suspicion of, or diagnosis of, cancer• Improvement Target: By March 2017, 10 specialties will have developed provincial standards of care

(clinical pathways) for their specialty and 80% of their patients will be receiving care consistent with those standards. By March 31, 2017, there will be a 50% reduction in value stream waste for the provision of cancer surgery/treatment

Prostate Assessment PathwayBackgroundProstate cancer is the most commonly diagnosed cancer in Canadian men. Historically, most men being assessed for and diagnosed with prostate cancer in Saskatoon have received this care from an Urologist. Following a diagnosis of prostate cancer Urologists traditionally provide information to assist men in making a decision about treatment. Decisions about treatment for prostate cancer are complex and many men struggle to determine the best treatment for them as there is often no “best” treatment. Lengthy wait times to be seen by an Urologist for assessment and following diagnosis, along with variance in the information provided, are concerns with this historic process.Prostate Assessment PathwayMembers for the Saskatchewan Cancer Agency, Saskatchewan Health Regions, Saskatchewan Ministry of Health and patient advisors began work on the Saskatchewan Prostate Assessment Pathway in August of 2010. The purpose of the pathway is to develop a standard approach to diagnosis, treatment and follow up, which will assist physicians and patients. The pathway will streamline access, standardize care, follow best practice and utilize a multi-disciplinary team approach. To facilitate the pathway, Prostate Assessment Centres in Regina and Saskatoon were established. Starting April 22, 2013 Primary Care Practitioners can now refer patients directly to these centres where nurse navigators will provide patients and their families with care and an expedited prostate biopsy.Urology Nurse Navigator RoleThe Saskatoon Prostate Assessment Centre is operated by Registered Nurses; also known as Urology Nurse Navigators. Navigators work with Urologists, Radiation Oncologists and Primary Care Practitioners to

provided care and services to patients and families being assessed for and diagnosed with prostate cancer. Currently in Saskatoon once patients receive a diagnosis of prostate cancer from an Urologist they are referred to the navigators who provide treatment counselling, education and support. Prior to the navigator role a patient newly diagnosed with prostate cancer could wait up to 3 weeks to be seen by an Urologist to have a discussion regarding their prostate cancer diagnosis and options for treatment. Navigator contact patient within 24 hours of referral to offer support and arrange an appointment to meet with the patient and family to discuss treatment options. The majority of patients meet with the navigator between 1-6 days following their diagnosis. Over the last year the navigators have worked alongside the Urologist to provide counselling, education and support to over 200 men and their families that have been diagnosed with prostate cancer in Saskatoon.Data CollectionPatient and Urologist satisfaction measures have been collected to assess the knowledge and effectiveness of the Urology Nurse Navigators role. There are plans in the future to continue measuring patient and physician satisfaction and volume, wait times and outcomes measures to monitor the effectiveness of the pathway and navigator role.ConclusionThe role of the Urology Nurse Navigator is a new and innovative concept that has already shown to improve patient and family experience. As the Prostate Assessment pathway is implemented and the navigator role continues to expand to provide further services, we hope to achieve more timely access for patients, improved standardized practices and an exceptional quality of care for patients and their families.

46

Hoshin: Transform the Patient Experience through Sooner, Safer, Smarter Surgical Care• Outcome: By March 2017, there will be a 50% reduction in patient wait times from GP referral to specialist

and diagnostic services• Improvement target: By March 2014, reduce by 90% the wait list variance within specialists services

What is being Done? The Breast Health Centre at Saskatoon City Hospital was expanded in October 2012 to include not only interventional radiology for the diagnosis of breast disease but a multi-disciplinary approach to breast health care. Patients are seen by a team of professionals including nurse navigators, surgeons, radiologists, physiotherapists and medical imaging technologists. Each week there are multidisciplinary rounds where surgeons, radiologists, medical and radiation oncologists discuss cancer cases and make recommendations for the most appropriate treatment options which are then discussed with the patient and their families. Plastic surgeons involved in breast cancer reconstruction also hold clinics in the Breast Health Centre.The nurse navigators within the Breast health Centre provide education, support, and provide a point of contact for patients should they have questions or are wondering what is next.Why is it important?Prior to the expansion of the program patients with abnormal mammograms in the community would be referred to the Breast Health Centre for a biopsy or other diagnostic testing. The results of that testing would then be sent to the referring physician, most often a family physician. If positive, the family physician would need to then have to initiate a referral to a surgeon. At times this could lead to delays or lost information. Now upon referral to the Breast

Health Program the patient is seen by the team. They are assessed by a surgeon prior to biopsy and depending on the results are booked for surgery, referred to the Cancer Centre or followed either in the clinic or with their primary care practitioner. This model reduces delays in care due to having to initiate multiple referrals or possible loss of information as it is sent from practitioner to practitioner.

What were our results in 2012-13?It is diffi cult to determine how much time has been reduced in the overall patient journey since the expansion of the Breast health Centre because it is extremely diffi cult to determine the amount of time patients waited to see a specialist after being referred. However, we know that by cutting out one step of the process we have reduced time. A recent patient satisfaction survey asked patients to rate various aspects of our care and overwhelmingly patients reported being very satisfi ed with the service and care. What are we doing about this?In 2013/14 we need to continue to streamline our processes and enhance our services to patients. We will be examining how to further integrate plastic surgery into the clinic. While 2012/13 focused on the initiation of the clinic the process outcomes related to starting a new program, this year we need to focus on outcome measures.

Hoshin: Transform the Patient Experience through Sooner, Safer, Smarter Surgical Care• Outcome: By March 2017, there will be a 50% reduction in patient wait times from GP referral to specialist

and diagnostic services• Improvement Target: By March 2017, 10 specialties will have developed provincial standards of care

(clinical pathways) for their specialty and 80% of their patients will be receiving care consistent with those standards

What is being done?Saskatoon Health Region has participated in the Saskatchewan Surgical Initiative provincial Pelvic fl oor Pathway working group over the past year. The pelvic fl oor pathway is designed to enhance the conservative management of female urinary incontinence and prolapse. It is based on a shared decision making model which helps the patient determine the best treatment options for them. This working group has developed program information booklets, workshops and pathway documents. While

the pathway was launched in Regina this spring, Saskatoon Health Region will plans to launch the clinic in Saskatoon in late fall. We faced considerable challenges in recruiting a nurse practitioner for the program and that role is vital for the full implementation. We expanded our pelvic fl oor physiotherapy capacity over the course of the year so more patients are receiving timely service for urinary incontinence.We will continue to work on the Saskatoon implementation plan over the upcoming months.

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Why is it important?The Pelvic Floor Pathway is important because it will provide patients with ready access to conservative treatment and the tools to make the best treatment decisions. Patients who are referred to the pathway will receive education on incontinence and prolapse and will be given tools to assist them in choosing options that work for their lifestyle. The pathway will offer physiotherapy, medication management and necessary fi tting to assist women reach their treatment goals. If conservative methods of treatment are not working or are undesirable or if the patient has any complicating medical factors they will be referred

onto the specialist either by their family doctor or the Nurse Practitioner. This pathway has the potential for patients to successfully manage their incontinence or prolapse without ever seeing a surgeon. What were our results in 2012-13?Staff has been recruited and minor renovations are occurring to the Women’s Health Centre at Saskatoon City Hospital to enable us to deliver the program.What are we doing about this?In 2013/14 Saskatoon Health Region plans to fully launch the pelvic fl oor pathway.

Hoshin: Transform the Patient Experience through Sooner, Safer, Smarter Surgical Care• Outcome: By March 31, 2014, all patients have the option to receive necessary surgery within 3 months• Improvement Targets: By March 2013, 100% of expected surgical case volumes by region delivered. By

March 2014 achieve the capacity needed to meet the established surgical throughput targets

What is being Done? Why is it important?The computerized Provincial Surgical Information System (SIS) Project implementation will be occurring in SHR-urban this fall. A dedicated provincial and SHR team are working hard towards making this project a reality. The goal is to implement an integrated system that facilitates standardization and automates a number of steps in the surgical episode. These steps include surgical scheduling and provincial wait list management, surgical charting in the OR, surgical supply chain, patient tracking and reporting.Impact in non-surgical areas: In addition, area(s) that currently receive a printed copy of the Operating Room Slate (weekly or daily). Once the project is implemented, the way we obtain and view the slate will be different. It will no longer be in paper form, but rather a real time, electronic version which can be viewed from any SHR (urban) user account computer. The OR’s will no longer be distributing paper copies. Throughout the previous fi scal year, SHR in conjunction with the provincial eHealth SIS team have been

laying the foundation for the project development and implementation. This has been in the format of working with IT services. For more information on the project visit http://www.health.gov.sk.ca/surgical-information-system.What were our results in 2012-13?Throughout the previous fi scal year, SHR in conjunction with the provincial eHealth SIS team have been laying the foundation for the project development and implementation. This has been in the format of working with IT services to develop server suitability, requirements and recruit a team from the Operating Room, Scheduling and Materials Management areas to develop the SHR program requirements. Full implementation of SIS Operating Room Manager (ORM)What are we doing about 2013-14?Full implementation of SIS Operating Room Manager (ORM) in all SHR -urban Operating Room.

Hoshin: Safety Culture: Focus on Patient and Staff Safety• Outcome: By March 31, 2017, no adverse events related to med errors• Improvement Targets: By 2015, med rec will be undertaken at all admissions and transfers/discharges in

acute, long-term care and community. By March 31, 2017, no adverse events related to med errors

What is being done?Admission Medication Reconciliation (AMR): AMR Form and Process have been implemented throughout Saskatoon Health Region. Goal: All patients admitted have Med Rec completed. Standard work and education program developed.Transfer Medication Reconciliation: Process for transfer Med Rec from acute care to Long Term Care (LTC) developed and spread to all sites. SHR will submit data to the Regional wall walk in June 2013. A process for

direct admissions from the community to LTC will be developed with spread completed by February 2014.AMR to Ambulatory Care: Process developed and spread completed to all renal services ambulatory clinics in 2012/2013. Next steps include revision to process and spread to the Positive Living Clinic, Heart Function Clinic, Cystic Fibrosis Clinic, Anticoagulation Management Clinic and mental health.

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Discharge Medication Reconciliation: Work to begin on 3 pilot areas in June: orthopaedics and cardiology at Royal University Hospital and Humboldt District Hospital. Quality methodology to be used. Baseline data collection; development of form and process, standard work, education package, and measurement plan to occur in next several months.Home Care Medication Reconciliation: Med Rec occurs for all clients admitted for Medication Management service, at 6 month reviews and when needed for signifi cant medication regimen changes. Med Rec on Transfer and Discharge processes were implemented in April 2013.Why is it important?Medication Reconciliation is an important patient safety initiative. It ensures the health-care team is aware of all the medications a patient is taking as they transition through the health-care environment. Medication reconciliation has many proven benefi ts: reduces medication errors and potential for patient harm, reduces duplication of medication lists, key component of seamless care strategies, and saves

time for physicians, nurses, and pharmacists. It is an Accreditation Canada Required Organizational Practice, a Saskatchewan Ministry of Health Strategic and Operational Direction and a Canadian Society of Hospital Pharmacists 2015 Objective.What were our results in 2012-13?In 2012-2013 93-100% of patients, each month, had a completed Med Rec form on their health record. Within the ambulatory nephrology clinics 90% or greater of patients have med rec completed. Completion of med rec in the hemodialysis population has increased from 18.6% to 70%.In 2012-2013, 78-84% of Med Management clients had a completed Med Rec form on their health record. Home Care nurses and family physicians are responsible for this process. 24-43% of Med Management clients had medication order discrepancies which were resolved.What are we doing about this?Goals, time lines and plans have been outlined as above for each individual area.

Hoshin: Safety Culture: Focus on Patient and Staff Safety

What is being measured?We've been auditing hand hygiene compliance in our health region for several years. However, as Saskatoon Health Region further commits to a safety culture, we have been putting more emphasis on hand hygiene than ever before.Why is it important?Typically, we observe about 8,000 opportunities for hand hygiene in our regular auditing. In 2012-2013, with our renewed emphasis on hand hygiene, we performed more than 50,000 observations. These statistics don't include the scrubs done prior to surgery. Those are done 100 per cent of the time by all surgical

team members.What were our results in 2012-13?In 2012/2013 we doubled the number of units and areas that were auditing their hand hygiene compliance and had 85% of all our areas auditing when and if providers were performing proper hand hygiene. We also increased our compliance rates to 79.3%. And while we know these numbers aren’t enough, they aren’t 100%, we do realize that there has been a huge amount of great work that’s been done across the region to begin to see hand hygiene compliance and auditing as part of our daily work. Hand hygiene is now being talked about at our

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Hoshin: Safety Culture: Focus on Patient and Staff Safety• Outcome: By March 2017, zero surgical infections from clean surgeries• Improvement Target: By 2017, 100% of surgeries will use the Surgical Site Infections bundle. By March 31,

2014, 100% of surgeries in an OR will use surgical safety checklists

visibility walls and we are beginning to see a change in our safety culture as we hold ourselves and our colleagues responsible for keeping everyone safe! What are we doing about this?Our focus for 2013/14 will again be to achieve 100% with both auditing and compliance. We will achieve this through focused efforts on spreading good hand hygiene practice through implementing training within industry (TWI) and through improving availability of hand gels throughout all of our facilities. This means

not only ensuring that hand gel dispensers are where they need to be, but that there is always hand gel available in the dispensers. This year we will also partner with Public Health to roll out the Germ Smart program within our facilities and create greater linkages with the work going on in our communities.

What is being done?Surveillance is performed by the Infection Prevention and Control team to identify clients who have developed surgical site infection (SSI) following certain operations in Saskatoon Health Region. Those operations where an infection would have the most serious impact are monitored (example heart, brain, total joint and vascular graft operations).The Safer Healthcare Now! surgical site infections bundle of preventive practices is monitored for several surgical procedures and for every case where infection is noted.Why is it important?Infection following surgery may have a life or limb altering impact on a client’s life. Some infections result in readmission, treatment with antibiotics, re-operation and prolonged recovery which add cost

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to the health-care system. The literature suggests that 30 -50% of surgical site infections may be prevented when best evidence for prevention is consistently used. What were our results in 2012-13?The number of surgical site infections identifi ed in 2012-13 was equivalent to that found in 2011-12 overall however substantial improvement was noted in certain procedure groups (for example the number of colon surgery infections declined from 21 to 12). Infections in several operative procedures and results of SSI bundle monitoring are reported monthly at the regional wall walk and at the Joint board quality and safety Committee.What are we doing about this?Surgical services and Infection Prevention and Control began a new process in 2012-13 to review each situation of surgical site infection as it is identifi ed. A meeting of involved care providers is arranged, the situation is reviewed, and actions are noted and undertaken. This real-time reporting has led to better awareness and problem solving in the team.

Hoshin (SHR specifi c): Improve Patient Flow for patients with complex medical needs• Outcome: By March 31, 2017, no patient will wait for emergency room care (patients seeking non-

emergency care in the ER will have access to more appropriate care settings).• Improvement Targets: By March 2014, improve patient fl ow and effi ciencies such that we achieve a

reduction of 50% admit-no-beds. By March 2015, the start of ER care time improved by 50%. By March 2015, eliminate holding of acute care admissions in ER

What is being done?Steps Saskatoon Health Region has taken in 2012-13 to improve patient fl ow include:• Opened 8 beds ‘overcapacity’ at RUH and

staffed them with fl oat pool staff regularly • Focused on COPD, as that is our highest # of

admissions and greatest variance in length of stay. Did RPIW that implemented standard order set and standard discharge planning

• Did work in two separate areas (one at RUH and one at SPH) that focused on housekeeping turnover, enhanced communication between providers to turn beds over, and creating a pull system out of ED

• Implemented Bed Management System in 3 acute care sites

• Completed RPIWs on medicine units that improved process of discharge planning to increase awareness of discharge readiness – including increased communication amongst care providers

• Implemented standard work to open additional

beds in a timely and effi cient fashion when patient volumes surge

• Initiated a review of alternate level of care designation for patients

• Trialing a surge indicator (ADR) to better predict surge activity and response

Why is it important?The emergency department is one of the busiest entry points into the health system. Once an individual enters the system there are several paths they may take, from being discharged home to being admitted and many permutations in between. Improving patient fl ow is a system wide approach to better manage the volume of patients we have entering the system while improving the patient experience. What were our results in 2012-13Of the 144,876 emergency department visits in 2012-13 15,996 patients had to wait in the emergency department for an inpatient bed. The average 6 hours and 43 minutes in the emergency department for an inpatient bed; this is an 18 percent improvement from the 8 hours and 16 minute wait time in 2011-12. The Region continues to improve in the percent of CTAS

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2 (urgent) patients seen within 15 minutes; starting in April 2012 with 37% and by March 2013 with 63%. There has been an improved length of stay for all CTAS levels in the emergency department.What are we doing about this?There is continued focus on patient fl ow in 2013-14. We have further work to do around predicting and managing historical trends (e.g. outbreak season). The implementation of an electronic bed management system will assist in improving fl ow by signalling bed availability thus developing a pull system from the ED. The Region is also examining factors contributing to re-visits/re-admission in order to identify opportunities for improving our practises that will result in a reduction of demand for service.

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Actual GoalDate Prepared: May 2, 2013Source: Sunrise Clinical Manager (SCM) Refresh Cycle: MonthlyOperational Def: Wait time from time bed called for to disposition timeBaseline: 2011/12 actual Plan Baseline

Better TeamsProvincial 5 year Outcomes Provincial Hoshins 2012-13 SHR Projects 2012-13

Increase physician engagement “score” by 50% by March 2017

Deploy a Continuous Improvement System including training, infrastructure across the health system with an initial focus on the surgical value stream and 3P within Five Hills, Prairie North, PAPRHA and Saskatoon

Addressed with Continuous Improvement plans

By march 31, 2017 the employee engagement provincial average score exceeds 80%

By March 31, 2017 zero work place injuries

Safety culture: focus on patient and staff safety

Addressed with Stop Workplace Injuries plans

Hoshin:• Outcome: By March 31, 2017, zero work place injuries• Improvement Target: By March 2017, 100% of patients, families, staff and physicians understand and are

comfortable with “stopping the line”.

What is being done?SHR has undertaken several initiatives in order to reduce the number of employee injuries. In 2012-13 there was an increased focus on Department Safety Plans. In doing so, we have identifi ed safety gaps in departments and have begun to align with education/training needs and Capital Equipment Requests.Work has begun on RUH 6300 as the model line for the province on the Safety Alert System/Stop-the-line. A

coalition group is guiding this process in combination with RPIW work.Why is it important?Safety is everyone’s job. SHR believes that as everyone gains an enhanced understanding of their responsibility in safety, the number of injuries will decrease. Safety needs to be embedded into our daily work. Any employee or patient injury is unacceptable. Each incident results in the use of valuable human and operational resources that could

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otherwise be deployed. A safe environment is fundamental to providing valued, best care to SHR patients, residents and clients.What were our results in 2012-13?Injury reduction was 9%What are we doing about this?Moving forward SHR is continuing to focus on building a culture of safety. Work is continuing on the Safety Alert System which includes building a reporting process that supports employees, patients and families, incorporating safety into daily visual management/huddles and engaging all employees and physicians in building a culture that promotes transparency in reporting and an openness to learning from our mistakes and moving forward.

Better ValueProvincial 5 year Outcomes Provincial Hoshins 2012-13 SHR Projects 2012-13

By March 2017, (based on a 5 yr. rolling average) the health care budget increase is less than the increase to provincial revenue growth

Identify and Provide Services Collectively Through a Shared Services Organization

Shared services plan: procurement, workflow and laundryBudget gap plan

By March 31, 2017 8% of the health care budget is strategically invested in IT, equipment and facility renewal

Infrastructure Stabilization plan

Deploy a Continuous Improvement System including training, infrastructure across the health system with an initial focus on the surgical value stream and 3P within Five Hills, Prairie North, PAPRHA and Saskatoon

Develop Kaizen Promotion Office (KPO) and related infrastructure for continuous improvement, in collaboration with Kelsey Trail and Heartland Health Regions Support lean training and certification Provide KPO support for 3P events, RPIWs, Kanban, Mistake PRooking Workshops and other CI activities

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Hoshin: Identify and Provide Services Collectively Through a Shared Services Organization• Outcome: By March 31, 2017, the health-care budget is strategically invested in IT, equipment and facility

renewal• Improvement Target: By March 31, 2017, reduce the gap percentage spent on IT as compared with high

performance organizations by 50% to achieve sustainable high quality service. By March 31, 2015, have achieved an accumulated total savings of $100M through shared services initiatives

What is being done?SHR ITS is working on baseline of non-discretionary expenses and discretionary capacity. Based on baseline data information, the next step is as part of ITS 2013-17 strategy, develop a process to understand what resources will be required to meet service levels, the changes required to support organizational unit plans, and the changes to IT needs . The expected outcome is budget plan proposal that would provide capacity requirements to meet organizational goals.SHR ITS engaged 3sHealth in areas of procurement and eHealth on service coordination based on value proposition.2013-14• Develop and tender a joint workstation/laptops/

tablets RFP (SRHA is taking the lead)• Develop and tender a joint Print devices RFP

(SRHA is taking the lead)2014-15• Develop and tender a joint server / network RFPWhy is it important?ITS must be capable of accurate fi nancial and staff forecasting in order to adequately support and manage SHR needs. This can reduce the strain on IT and limit wasted efforts by increasing the accuracy of proposed and approved) budgets. Determine where

improvements can be made, costs can be cut, and benefi ts can be realized. It would create architectural and product standards allowing us to leverage value of scale, and derive administrative effi ciencies from product standards across the province.What were our results in 2012-13?SHR ITS 2012-13 budget was developed based on the zero-based methodology. Forces management to review entire cost base. Highlights cost drivers and controls weaknesses.SHR leveraged provincially negotiated contracts (through 3sHealth) on VOIP technology to start replacing SHR outdated telephony infrastructure. Completed – St. Paul’s Hospital, Watrous Hospital, Station 20 West In planning/execution stages – Royal University hospital, Wadena Hospital, SCA (partnership), Idylwyld Centre and Saskatoon City HospitalWhat are we doing about this?Next steps: • IT Asset Management strategy and governance• Life-cycle management of IT Assets proposal• Optimization of opportunities in three major

steps: by introducing service-level tiering, by implementing a shared capacity planning process, and by consolidating vendor relationships.

Hoshin: Identify and Provide Services Collectively Through a Shared Services Organization• Outcome: By March 31, 2017, the health-care budget is strategically invested in IT, equipment and facility

renewal• Improvement Target: By March 31, 2017, reduce the gap percentage spent on IT as compared with high

performance organizations by 50% to achieve sustainable high quality service. By March 31, 2015, have achieved an accumulated total savings of $100M through shared services initiatives

What is being Done?Although facility infrastructure renewal is not yet a provincial hoshin, the SHR has begun the groundwork of information gathering and risk prioritization. Infrastructure defi ciencies continue to be managed with temporary solutions. In the fourth quarter, SHR participated in the provincial planning for facility re-assessments to be completed by the fall 2013.Why is it important?Infrastructure renewal investment is key to maintaining

the availability of the physical environment and assets which is a key component of the Saskatchewan Healthcare Management System. In order to achieve a safe, reliable, and comfortable environment, predictable and regular investments in facility/asset renewal are required. As outlined in various assessments and engineering reports, the condition of SHR’s facility and equipment assets is less than optimal. The challenges of aging infrastructure and related maintenance are expected to continue,

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and these issues will continue to require attention as the Region implements a lean management system to meet the health-care needs of people in Saskatchewan.What were our results in 2012-13?In 2012-13, several projects related to roofi ng, heating systems, water/gas systems, and structural defi ciencies were undertaken and a signifi cant portion of the projects were completed by end of fi scal year. However, many additional infrastructure assets have begun to fail and the level of failure is exceeding the

capital funds available to effectively manage these risks.What are we doing about this?The SHR is working with the Ministry of Health and other regions to re-assess all health-care facility assets in the summer of 2013. This work is foundational to providing accurate information regarding our collective risk profi le to decision makers and funders of the health system. In addition to this work, SHR continues to monitor emerging risks and failures in order to provide temporary risk mitigation plans while awaiting capital investment.

Hoshin: Deploy a Lean Management System including training, infrastructure across the health system with an initial focus on the surgical value stream and 3P within Five Hills, Prairie North, Prince Albert Parkland and Saskatoon• Outcome: By March 31, 2017, the health-care budget is strategically invested in IT, equipment and facility

renewal• Improvement Target: By March 31, 2016, 880 health-care leaders will be certifi ed in lean. By March

31, 2017, more than 1,000 focused quality improvement events involving front-line staff, physicians and patients will be undertaken in multiple areas of the health system, in order to improve the patient experience and reduce error. By March 2017, 25% of staff and clinicians are trained in continuous improvement basics. By March 2017, 400 staff will be dedicated to continuous improvement

KPO DevelopmentBeginning in April 2012, Saskatoon Health Region brought together the functions of Quality Services, Planning and Strategic Health Information Planning Services (SHIPS) to form the Kaizen Promotion Offi ce (KPO). Staff were transitioned from a variety of positions and areas of focus to assume new roles within the KPO. All KPO staff were enrolled in Lean Leader Certifi cation to obtain the needed skills to function as Kaizen leaders. The KPO is the glue that holds all the improvement work and the Region’s lean management system together by providing the rules, tools and methods of running kaizen events, providing support for training and certifi cation for all lean leaders and kaizen events, and providing planning and strategic direction for the organization,The Infrastructure Pillar in the KPO is responsible for the development and implementation of the supportive infrastructure for all Kaizen related activities across Saskatoon Health Region and its affi liate organizations. The Infrastructure pillar serves as a liaison between the Kaizen Promotion Offi ce and Kaizen Operation Teams (KOT) to direct scheduling of events and ensure consistency of practice in the application of methodology and tools including maintenance of documentation and records and reports for all Kaizen activities. The pillar coordinates and ensures the rigorous application of Kaizen concepts, tools and methodologies to support achievement of organizational goals and implementation of the Saskatchewan Healthcare Management System

(modeled after the Global Production System). The Certifi cation and Training Pillar of the KPO guides the development and refi nement of the Kaizen education and certifi cation program for Saskatoon Health Region and its affi liate organizations. The certifi cation and training pillar coordinates organizational delivery, maintenance and document control in relation to Lean Leader Certifi cation, Kaizen Basics, the North American Tour, Training Within Industry (TWI) as well as the coordination and leadership for the Region’s Kaizen internship program.The KPO Planning Pillar serves to enable the development and implementation of the supportive infrastructure for strategic (Hoshin) planning, the Region’s cascading visual management system and decision support across Saskatoon Health Region and its affi liate organizations. The Planning Pillar serves as a liaison between the Kaizen Promotion Offi ce, Kaizen Operation Teams (KOT) and senior leaders to direct scheduling and support of strategic planning events and the development of linked visual management systems, ensuring consistency of practice in application of methodology and tools.Key Milestones Accomplished 2012-13• Transitioned Quality Services staff to new KPO roles

and recruited KOT (Kaizen Operational Team) Lead for four service lines: 0 Adult Medicine and Complex Care (AMCC), 0 Surgical Services,

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0 Maternal and Children’s Health Services, 0 Finance and Corporate Services.

These four services lines have been chosen for support by the KPO because they are directly linked to the Children’s Hospital of Saskatchewan (CHS). CHS has been designed with lean principles embedded and as such the Region is focusing process improvement work on the areas that will be operating in CHS. The KOT Leads are accountable for embedding the kaizen events in operations areas and achieving the set targets.• Hoshin Kanri: Supported the organization’s leaders

in the hoshin kanri process (strategy deployment) and carried out Diagnosis and Review and Catch ball sessions.

• Created value stream maps for the four service lines including Current state map and future state maps 2013/14, 2014/15, and 2015/16 with targets.

• RPIWs: Completed 31 RPIWs. Selection of scope and focus of the 40 RPIWs taking place in 2013-14.

• 5S: Provided support for 30 5S projects taking place before an RPIW.

• Mistake Proofi ng: Completed 6 Mistake proofi ng projects. Selection of scope and focus of 6 mistake proofi ng projects taking place in 2013-14

• Training Within Industry (TWI): Completed 3 Job Instruction training sessions and certifi ed 31 job instructors.

• Kanban: Implemented a kanban system in four different work units (NICU, Labour and Delivery, ICU, and RUH 5000).

• Visual Management: Completed two-hour workshop for each director portfolio. Provided the structure for and supported the weekly Regional Wall Walk.

• Kaizen Basics: Delivered 50 one-day training sessions of Kaizen Basics with an overall attendance of over 2800 SHR staff and physicians.

• Lean Leader Training: Completed two waves of Lean Leader Training for 87 SHR staff and physicians. Created a certifi cation plan to enable priority Lean Leaders to complete within 24 months.

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2012-13 Financial OverviewYear-to-date operating budget variance (YTD variance as a percentage of budget)Total expenditures for 2012-2013 were $1.084 billion. On average, Saskatoon Health Region spent $2.97 million per day to meet the health needs of the community. Overall 92.7 percent of operating revenue was provided by funding from the Ministry of Health.

About 68 percent of the operating funding was spent on providing services to patients and residents in our facilities, 12 percent on community-based, primary health, home care and mental health services, 13 percent on operational support and 7 percent on support services and ancillary. In 2012-2013 salaries and benefi ts accounted for approximately 78 percent of the spending.

Saskatoon Health Region’s operating results for the year ended March 31, 2013, refl ect a defi cit of $24.2 million. This is equivalent to 2.2 percent of overall expenditures or approximately 8.2 days of operation.

Saskatoon Health Region began the 2012-2013 fi scal year with a $33 million shortfall in revenues over expenses. Savings strategies to balance the budget were compromised by higher than anticipated volume pressures. The Health Region continues to experience the largest share of the increase in population growth in Saskatchewan as well as increased out of region population that utilizes Health Region services. These volume pressures have masked some of the effi ciency gains that have been made in various units as refl ected in a decrease in their average cost per unit.

The resulting increases in patient volumes and acuity compared to 2011-2012 account for $12.64 million of the defi cit. Compared to the previous year, adult and child patient days increased by 2.4 percent (6,447 days), newborn days were up 4.3 percent (802 days), deliveries increased by 6.7 percent (326 deliveries) and emergency visits increased by 2.0 percent (2,350 visits). Regional Home Care Services experienced signifi cant growth during 2012-2013, home nursing visits increased by 8.8 percent (18,964 visits) and home services visits increased by 3.1 percent (16,335 visits).

At March 31, 2012 the Health Region had reported an overall defi cit of $7.1 million which has carried forward into the current year. Higher than anticipated costs in Rural Health amount to $1.0 million; lower than planned sundry revenues amounted to $1.1 million, higher costs for surgeries compared to targeted revenues amounted to $1.5 million, the remaining $0.9 million is attributable to other items including investments in KPO, supply infl ation net of procurement savings and increased cost of demand maintenance.

The Region experienced additional labour costs, primarily in the areas of overtime, sick time, and orientation costs. Total paid sick hours increased from last fi scal year by 3.7 percent, paid overtime hours decreased by 3.5 percent, orientation hours increased by 8.5 percent and total paid full time equivalents increased by 2.0 percent.

The capital expenses for 2012-2013 were $43.2 million; The Health Region received capital funding of $32.4 million. Overall, 37 percent of capital revenue was provided by funding from the Ministry of Health. The remainder of the funding was received from various sources such as the foundations and investment income. The Capital Fund ended the year with a defi cit of $10.8 million due to funding received in prior years that was utilized in this fi scal year.

Approximately 39 percent of the capital spending was spent on medical equipment, diagnostic imaging equipment and information technology while 61 percent was spent on capital and infrastructure projects.

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Glossary3P (Production, preparation, process) - a lean tool often used in facility design and is based on creating new processes for an area and/or using those new processes to develop a design. The focus is on the patientand creating defect free processes.

3sHealth - a provincial organization that provides province-wide shared services to support a high performing, sustainable, patient and family centred health system in Saskatchewan.

5S - Five terms beginning with ‘S’ used to create a clean and well-organized workplace. (sort, simplify, sweep, standardize, sustain)

Canadian Triage and Acuity Scale (CTAS) - categorizes patients by injury and physiological fi ndings, and ranks them by severity from 1 to 5; common frame of reference for health-care workers in determining the urgency of a medical situation in the emergency department.

eHealth - a provincial organization responsible for creating a provincial electronic health record with all clinically relevant health information stored in one place.

Gemba - Where the daily work happens and where value is created for the patient, resident or client.

Kaizen - Japanese term for “continuous improvement;” typically, a short burst of team effort aimedat improving part of a process.

Kaizen Promotion Offi ce (KPO) - the department responsible for leading Saskatoon Health Region’s improvement efforts; supports the training, coaching and development of the Region’s lean leaders and supports the planning and implementation of continuous improvement work.

Kanban - A way of automatically signalling when new parts, supplies or services are needed.

Lean - a patient-centred approach to identifying and eliminating all non-value-adding activities and reducing waste within an organization.

LiveWell - a program of Saskatoon Health Region Primary Health Care designed to assist clients and families adjust to a chronic disease.

Rapid Process Improvement Workshop (RPIW) - Week-long improvement events where a RPIW team focuses on one problem, identifi es the root causes, creates and tests solutions, and by week’s end, is ready toimplement the solution in the workplace.

Training Within Industry (TWI) - a standardized method of training individuals in a process.

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Level 2 AdministrationSaskatoon City Hospital701 Queen StreetSaskatoon SK S7K 0M7(306) 655-7500

[email protected]

For a list of payees, suppliers and other appendices, please visit www.saskatoonhealthregion.ca.

http://www.saskatoonhealthregion.ca/about_us/documents/shr_annual_report_2012_13_appendices.pdf

saskatoon health region...portfolio was jointly led by sandra blevins, dr. alan casson, and jackie...

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